Long-Term Results of Gastric Bypass Surgery in Morbidly Obese Type 1 Diabetes Patients

Czupryniak, Leszek; Wiszniewski, Marcin; Szymański, Dariusz; Pawłowski, Maciej; Loba, Jerzy; Strzelczyk, Janusz

doi:10.1007/s11695-010-0074-6

Cited by 42 publications

(32 citation statements)

References 15 publications

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“…Of the studies quoted by Brethauer et al, we agree that two showed HbA 1c improvement in all patients (2,3). However, the third study reported that two of three patients experienced deterioration (4).…”

mentioning

confidence: 56%

Comment on Brethauer et al. Bariatric Surgery Improves the Metabolic Profile of Morbidly Obese Patients With Type 1 Diabetes. Diabetes Care 2014;37:e51–e52

et al. 2014

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mentioning

confidence: 56%

Comment on Brethauer et al. Bariatric Surgery Improves the Metabolic Profile of Morbidly Obese Patients With Type 1 Diabetes. Diabetes Care 2014;37:e51–e52

et al. 2014

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“…Such beneficial effects on obesity-related comorbidities can also be extrapolated to severely obese patients with T1D. Improvement in lipid profile (30)(31)(32)(33)38,39,(41)(42)(43)(44) and blood pressure (30,31,38,39,41,45) was shown in some studies. In one comparative series, remission rates of hypertension and dyslipidemia were similar among patients with T1D and T2D after bariatric surgery (31).…”

Section: Impacts On Obesity and Diabetes Comorbiditiesmentioning

confidence: 97%

Bariatric Surgery in Obese Patients With Type 1 Diabetes

et al. 2016

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OBJECTIVEThere is a paucity of data on the impact of bariatric surgery in type 1 diabetes (T1D). The aim of this review was to quantify the overall effects of bariatric surgery in obese patients with T1D. METHODSWe searched PubMed, Scopus, ISI Web of Knowledge, and Google Scholar from their inception to December 2015 to identify all relevant studies of bariatric surgery in adult obese patients with T1D. RESULTSThe review included 17 studies with 107 individuals, including 10 case series and 7 case reports. Overall, the dominant procedure was gastric bypass (n = 70; 65%). All studies reported a significant reduction in excess weight. A significant reduction in weight-adjusted daily insulin requirements was shown in all case series except one. Pooled mean 6 SD of pre-and postoperative glycated hemoglobin (HbA 1c ) for the entire cohort with available data (n = 96) was 8.4 6 1.3% and 7.9 6 1.1%, respectively (P = 0.01). In addition to common postoperative complications, profound glycemic changes (diabetic ketoacidosis and hypoglycemia) and gastrointestinal dysmotility symptoms (prolonged ileus and acute gastric remnant dilation) have been reported. No surgical mortality was reported. CONCLUSIONSBariatric surgery leads to significant weight loss in severely obese patients with T1D and results in a significant improvement in insulin requirements and glycemic status. The favorable metabolic effects of bariatric surgery may facilitate medical management of and cardiovascular risk reduction in T1D in the setting of severe obesity. Diabetic ketoacidosis and hypoglycemia are potentially serious complications. Short-term results of bariatric surgery in patients with T1D are encouraging, but larger and longer-term studies are needed.Patients with type 1 diabetes (T1D) constitute about 5-10% of all cases of diabetes. Large epidemiologic studies indicate that the worldwide incidence of T1D has been increasing in recent decades (1,2). T1D is associated with serious long-term complications that affect the cardiovascular system, eyes, kidneys, and nervous system and predispose to certain infections (3), which can lead to substantial increased mortality rates compared with the nondiabetic population (4,5).The prevalence of obesity among youth with T1D in the U.S. was found to be 12.6% (6). Overall, approximately 50% of patients with T1D are currently obese or overweight, and between 20 and 40% meet the criteria of metabolic syndrome, depending on the study population and the diagnostic criteria used (7). Excessive

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“…These surgical interventions have been shown to provide long-term control of T2D. 29,30 Surgical interventions in non-morbidly obese patients (BMI < 35)…”

Section: Epidemiology and Aetiopathogenesis Of Diabetesmentioning

confidence: 99%

Structural changes in intestinal enteroendocrine cells after ileal interposition in normal rats

et al. 2011

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INTRODUCTION:No therapeutic approach has significantly impacted the progression of diabetes. As early improvement of glicaemic control is observed after bariatric surgeries, there is currently a search for surgical procedures that can promote euglycemia also in non-obese patients. Glicaemic control can be achieved by increasing the blood concentration of GLP-1, a hormone produced by L cells that are more densely concentrated in the terminal ileum. The interposition of ileal segment to a more anterior region (proximal jejunum) can promote a greater stimulation of the L cells by poorly digested food, increasing the production of GLP-1 and reflecting on glicaemic control. AIMS:To investigate long-term histological modifications of intestinal mucosa of rats submitted to interposition of ileum segment to a proximal region (jejunum). METHODS:Forty 8-week old male Wistar-EPM1 rats (Rattus norvegicus albinus) were randomly distributed into 3 groups: the Interposition Group (IG) was subjected to ileal interposition, the Sham Group (SG) was subjected to sham operations, and the Control Group (CG) was not subjected to surgery. All animals were followed until the 60 th postoperative day (8 postoperative week) when they were euthanized. Segments of jejunum and ileum from all groups were collected and analyzed by optical microscopy and immunohistochemistry. RESULTS:No structural nor histological changes in intestinal L cells in the interposed intestinal segment and other intestinal segments were noted after ileal interposition surgery. CONCLUSION:As L cells endocrine characteristics were likely maintained, the use of metabolic surgical techniques for the treatment of metabolic diseases, especially diabetes, seems to be justified.

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Long-Term Results of Gastric Bypass Surgery in Morbidly Obese Type 1 Diabetes Patients

Cited by 42 publications

References 15 publications

Comment on Brethauer et al. Bariatric Surgery Improves the Metabolic Profile of Morbidly Obese Patients With Type 1 Diabetes. Diabetes Care 2014;37:e51–e52

Comment on Brethauer et al. Bariatric Surgery Improves the Metabolic Profile of Morbidly Obese Patients With Type 1 Diabetes. Diabetes Care 2014;37:e51–e52

Bariatric Surgery in Obese Patients With Type 1 Diabetes

Structural changes in intestinal enteroendocrine cells after ileal interposition in normal rats

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