Five-year outcomes of single-anastomosis duodeno-ileal bypass with sleeve gastrectomy (SADI-S) in adults with type 1 diabetes mellitus.

BACKGROUND

Managing obesity in adults with type 1 diabetes mellitus (T1DM) is challenging because insulin dependence often coexists with significant insulin resistance. While metabolic surgery is well established in type 2 diabetes, long-term data in T1DM remain limited. This study evaluates five-year outcomes of single-anastomosis duodeno-ileal bypass with sleeve gastrectomy (SADI-S) in adults with T1DM.

MATERIALS AND

METHODS

Adults with T1DM and obesity who underwent primary SADI-S at a single center were followed for up to five years. Outcomes included weight, BMI, HbA1c, total daily insulin requirements, continuous glucose monitoring (CGM) metrics, nutritional status, peri-operative safety, and patient-reported quality-of-life measures. CGM data were analyzed for time in range, glycemic variability, time above range, and time below range. Patient-reported outcomes included the SF-12, Diabetes Treatment Satisfaction Questionnaire, and BAROS.

RESULTS

Eight patients contributed five-year outcome data. Mean BMI decreased from 38.6 kg/m² to 26.4 kg/m². HbA1c improved from 8.4% to 7.1%, and total daily insulin requirements decreased by approximately 45%. CGM data demonstrated increased time in range, reduced glycemic variability, and stable rates of hypoglycemia. Quality-of-life scores improved across all validated domains. Two cases of early postoperative euglycemic diabetic ketoacidosis occurred before implementation of extended inpatient monitoring; none occurred thereafter. No patient developed protein-calorie malnutrition or severe micronutrient deficiency.

CONCLUSIONS

SADI-S produced sustained weight loss, improved glycemic stability, reduced insulin requirements, and acceptable nutritional outcomes over five years in adults with T1DM. These findings support SADI-S as a physiologically favorable metabolic procedure in carefully selected insulin-treated individuals.