Bariatric surgery in adults with type 1 diabetes and obesity: a 3-year observational matched cohort study.

BACKGROUND

Bariatric surgery (BS) is an effective long-term weight management option for individuals with type 1 diabetes (T1D) and obesity. However, the long-term effects of BS on glycemic control and cardiovascular (CV) risk factors in individuals with T1D remain unclear, and few studies have directly compared BS outcomes with a matched cohort receiving standard diabetes care.

OBJECTIVES

To evaluate the impact of BS on weight, insulin requirements, glycemic control, and CV risk factors in individuals with T1D and obesity, compared to standard diabetes care.

SETTING

Joslin Diabetes Center, Boston, MA, United States.

METHODS

This was a retrospective cohort study of 20 adults (mean age 41 ± 10 years) with T1D and obesity who underwent BS (Roux-en-Y gastric bypass 75%, sleeve gastrectomy 15%, and laparoscopic gastric banding 10%). A matched cohort (1:1 ratio) of 20 adults receiving standard diabetes care (mean age 43 ± 12 years) was selected. Baseline characteristics included similar body weight, diabetes duration, and glycemic control. Data on body weight, hemoglobin A1C, insulin use, lipid profile, and blood pressure were collected at baseline and after 3 years.

RESULTS

After 3 years, the BS cohort experienced weight loss of 33.5 ± 2.6 kg (28.1 ± 2.2%), while the standard care group gained 2.6 ± 2.8 kg (2.2 ± 2.4%, P < .0001). Hemoglobin A1C and low-density lipoprotein cholesterol levels remained unchanged in both groups. However, the BS group showed a reduction in insulin dose, weight-adjusted insulin requirements, triglycerides, systolic blood pressure, and antihypertensive medications. High-density lipoprotein cholesterol increased in the BS group compared to the standard care cohort.

CONCLUSIONS

BS reduces body weight, insulin requirements, and several CV risk factors in individuals with T1D and obesity, although it does not improve long-term glycemic control. Further prospective randomized clinical trials are needed to confirm these findings.