Symptoms
Causes
Complications
Does bariatric surgery help type 1 diabetes?
In a small series, bariatric surgery produced a large and sustained weight loss in severely obese patients with type 1 diabetes. There was also a significant mean reduction in A1C and daily insulin requirement as well as improvement in cardiovascular risk factors.
Can diabetes be cured by bariatric surgery?
Weight-loss surgery, also called bariatric surgery, can be done in minimally invasive ways and can be used to treat Type 2 diabetes. The surgery treats diabetes by controlling how much sugar is in the blood. One type of surgery is called the duodenal switch.
Is there any surgery for type 1 diabetes?
Islet Cell Transplant This procedure takes healthy islet cells from a donor and injects them into a vein. The cells will make insulin. It will need to be done more than once. It can help a person manage their blood glucose.
Is gastric bypass better for diabetics?
THURSDAY, Feb. 7, 2019 (HealthDay News) -- As many as 7 out of 10 people with type 2 diabetes can achieve long-term disease remission by having weight-loss surgery called gastric bypass, according to a new Danish study.
Which bariatric surgery is best for diabetes?
The new analysis projected that gastric bypass leads to greater weight loss and a greater rate of remission of diabetes than sleeve gastrectomy or medical therapy, which involves lifestyle counseling and medication. Gastric bypass surgery also was projected to produce the best results regardless of diabetes severity.
Can diabetes come back after gastric bypass?
A new study shows that although gastric bypass surgery reverses Type 2 diabetes in a large percentage of obese patients, the disease recurs in about 21 percent of them within three to five years.
Can a Type 1 diabetic get a pancreas transplant?
A pancreas transplant allows people with type 1 diabetes (insulin-treated diabetes) to produce insulin again. It's not a routine treatment because it has risks, and treatment with insulin injections is often effective.
Can type 1 diabetes be treated without insulin?
For people with “traditional” T1D, particularly those diagnosed in childhood or adolescence, to survive without insulin, “they would need to stay on carbohydrate restriction and stay very hydrated,” Kaufman says. But their survival rate is “multiple days, to a few weeks, getting sicker and weaker as time goes on.
Does gastric sleeve shorten your life?
The adjusted median life expectancy in the surgery group was 3.0 years (95% CI, 1.8 to 4.2) longer than in the control group but 5.5 years shorter than in the general population. The 90-day postoperative mortality was 0.2%, and 2.9% of the patients in the surgery group underwent repeat surgery.
Does gastric sleeve help with insulin resistance?
Sleeve gastrectomy leads to a drastic improvement in severe insulin resistance as early as the first postoperative day.
Why is my blood sugar high after gastric bypass?
Altered glucose delivery after gastric bypass In patients after RYGB, nutrient emptying from the gastric pouch to the gut is accelerated by 100-fold, leading to earlier and higher peak of glucose and lower nadir glucose levels compared to nonoperated individuals [2].
What is bariatric surgery?
Bariatric surgical procedures consist of either gastric banding or involve bypassing, resecting, or transposing portions of the stomach and sections of the small intestine [1]. The objectives of bariatric surgery (BS) are to reduce alimentary capacity, induce a malabsorptive situation, or both.When performed by a skilled surgeon and with input from a multidisciplinary team of professionals, metabolic surgeries can be effective weight loss treatments for severe and morbid obesity [2].Ideally, the bariatric intervention should be part of a comprehensive weight management program with the availability of lifelong lifestyle support and medical monitoring [3]. Diabetes mellitus is representative of the major chronic health conditions that could be ameliorated or even remitted with the significant amount of weight loss and metabolic changes that occur after BS. Historically, BS has been used in patients suffering from type 2 diabetes (T2DM). Impressive weight loss and glycemic improvement, and even cessation of pharmacologic therapies, has been achieved [4]. In contrast, BS has not been utilized or studied to the same degree in type 1 diabetes (T1DM), and its advantages and drawbacks in this patient population remain to be fully elucidated.
Why is obesity more prevalent in T1DM patients?
The major reason behind this epidemiologic change is the increase in sedentary habits and dietary changes that is impacting all ages and societies. The latter is disproportionately affecting children and youth. It is estimated that the prevalence of overweight in young adults with T1DM ranges from 12.5% to 33.3% [12]. The increased emphasis on attaining glycemic goals and use of intensive insulin regimens has resulted in a higher rate of severe hypoglycemia and contributed to the propensity to weight gain. Thus, approximately 50% of patients with T1DM are currently obese or overweight, and between 8% and 40% meet the metabolic syndrome criteria [13,14].
Is bariatric surgery good for diabetes?
Bariatric surgery has emerged as a viable treatment option in morbidly obese individuals with type 2 diabetes. Concomitant with societal lifestyle changes and the increased emphasis on achieving metabolic targets, there has been a rise in the number of patients with type 1 diabetes (T1DM) who are overweight and obese. Preliminary experience based on a limited number of observational reports points to substantial weight loss and amelioration of comorbid conditions such as blood pressure and dyslipidemia in patients with T1DM who undergo weight loss surgery. However, there is little evidence to suggest significant improvement in glycemic control and lowering of glycosylated hemoglobin, and bariatric surgical procedures do not necessarily lead to enhanced diabetes management. and improved quality of life.The potential possibility of micronutrient deficiency, weight regain, and psychobehavioral issues post-bariatric surgeryalso exists. An individualized evaluation of the risks and benefits should be considered, using a a multidisciplinary team approach with expertise in patient selection, surgical technique, and follow-up. A crucial component is the availability of a diabetes care specialist or endocrinologist experienced in intensive, tailored, modifiable insulin regimens who maintains close and careful monitoring during all phases ofmanagement.Reliable data from a prospective, longitudinal perspective is required to provide guidelines for clinicians and informed choices for obese patients with T1DM who are contemplating bariatric surgery.
Introduction
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 ).
Methods
We 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 patients with T1D, regardless of language or publication status.
Summary
It is expected that the need for bariatric surgery in patients with T1D will increase in the future, since the prevalence of severe obesity among this population has considerably increased during the past decade ( 70 ).
Article Information
Duality of Interest. No potential conflicts of interest relevant to this article were reported.
What is a bariatric surgery procedure?
The main procedures include (a) adjustable gastric banding (AGB) where an adjustable gastric band is placed around the upper part of the stomach to reduce the stomach size, (b) vertical sleeve gastrectomy (VSG), where a tubular stomach is created by partial gastrectomy of the greater curvature side, (c) Roux-en-Y gastric bypass (RYGB), where a small gastric pouch is created from the proximal portion of stomach and is connected to the distal end of the small intestine by gastro-jejunal anastomosis, while entero-enteral anastomosis 100–150 cm distal to the gastro-jejunostomy site restores bowel continuity between the bilio-pancreatic limb and the alimentary limb, and (d) biliopancreatic diversion (BPD) with or without duodenal switch, where gastrectomy is done to reduce the stomach capacity, the stomach is connected to the distal small intestine and the excluded bilio-pancreatic limb is connected to the alimentary limb distally. The most commonly applied procedures are RYGB and VSG ( 14 ). However, all these techniques have been mainly studied in T2DM; studies that refer to T1DM are mostly retrospective, with a limited number of patients with heterogeneous characteristics. The most beneficial results are observed in terms of weight loss and daily insulin requirements, while data about improvements in HbA1c demonstrate modest and contradictory outcomes. The main results are summarized in Table 1.
What is double diabetes?
The term “Double Diabetes” has been introduced to describe this type of diabetes in which factors typical of both type 1 and type 2 diabetes co-exist. Bariatric surgery has been suggested as an effective treatment for these patients, although data is scarce, based on case series and retrospective studies.
Is bariatric surgery effective for T1DM?
The term “Double Diabetes” has been introduced to describe this type of diabetes in which factors typical of both type 1 and type 2 diabetes co-exist. Bariatric surgery has been suggested as an effective treatment for these patients, although data is scarce, based on case series and retrospective studies. Bariatric surgery results in a significant reduction in body mass index, in total daily insulin requirements and in co-morbidities related to obesity. However, its effect on glycemic control in T1DM is controversial, as sustainable and meaningful reductions in HbA1c have not been invariably achieved. Apart from the common complications of BS, diabetic ketoacidosis and hypoglycemia are life threatening conditions with increased prevalence in T1DM patients, which require special concern and whose causal mechanisms are still unclear. Improvement in beta cell function, reduction of hepatic and peripheral resistance and modifications in glucose absorption are some of the mechanisms through which BS improves glycemic control in both type 1 and type 2 diabetes suggesting that the two types of diabetes have partially a common pathophysiological pathway; however, the inadequate glycemic control post-surgery has not yet been explained. In conclusion, bariatric surgery is not yet to be recommended routinely to all T1DM patients. For the time being, those patients with LADA considered the most appropriate candidates for surgery when the operation is conducted at the early stages of the disease, as the surgical intervention preserves beta cell mass and delays progression to total insulin deficiency. For all the other T1DM patients, a careful and multidisciplinary approach is necessary, where individualized and realistic goals will be set. Randomized, prospective trials are required to conclusively evaluate the effects of surgery in T1DM both in short and long term and define the most suitable candidates who will benefit the most out of it.
Does bariatric surgery affect beta cells?
Bariatric surgery attenuates the dysfunction of beta cells by increasing beta cell sensitivity ( 66 ). As it is obvious, in the setting of T1DM, such an action is meaningful only in cases of residual beta cell function. The physiological pathways which mediate this enhancement have been poorly clarified. Caloric restriction, removal of glucose toxicity and gastrointestinal hormone modulation have been proposed; however, it seems that a main mechanism is the enhanced glucagon-like peptide-1 (GLP-1) secretion after surgery. The rapid and early delivery of nutrients to the distal small intestine potentiates the secretion of distal gut peptides, mainly glucagon-like peptide-1 (GLP-1) and peptide YY (PYY) ( 67 ). Post-prandial concentration of GLP-1 rises almost 10-fold in the first few days after RYGB, and similar increases are observed after SG and BPD, but not after AGB ( 68 – 70 ). The importance of exaggerated post-prandial responses of GLP-1 post-operatively has not been studied specifically in T1DM patients after metabolic surgery, however it has been confirmed in studies where the GLP-1 receptor was blocked with exendin ( 9 – 39) and blunted insulin responses were reported after meals ( 71, 72 ). In a study by Scrocchi et al. ( 73 ), a defective glucose-stimulated insulin secretion was noted in mice which were deprived of the GLP-1 receptor in β-cells (GLP-1R −/− ), while in another murine model of diabetes, the administration of GLP-1R agonist exendin-4 attenuated translational downregulation of insulin and improved beta cell survival ( 74 ). Similarly, in a tamoxifen-inducible GLP-1R knockout mouse model, augmentation of glucose-stimulated insulin secretion during an oral glucose tolerance test (OGTT) after VSG was blunted in the knockout mice compared to the control group ( 75 ); such results were reproduced in another study on humans after RYGB, where administration of exendin 9–39 decreased insulin concentrations (12.3 ± 2.2 vs. 18.1 ± 3.1 nmol/6 h) and β-cell response to glucose post-prandially compared to controls ( 76 ). In addition, some researchers have attributed post-RYGB hyperinsulinemic hypoglycemia to GLP-1-mediated expansion of β-cell mass (nesidioblastosis) ( 77, 78 ), with reversal of the symptoms after blockade of GLP-1 receptor with exendin 9–39 ( 79 ). Contrary to these results, a human study comparing RYGB patients with a group undergoing an intensive lifestyle modification therapy showed no differences in glucose tolerance deterioration after the infusion of exendin 9–39 ( 80 ). Similar results were demonstrated in animal studies, where the infusion of exendin 9–39 in GLP-1R −/− and wild type mice which underwent RYGB or VSG resulted in similar glucose tolerance ( 81, 82 ). Therefore, the role of enhanced GLP-1 secretion after bariatric surgery on β-cell function remains to be clarified. As for the other major incretin, glucose-dependent insulinotropic polypeptide (GIP), evidence is inconsistent, with studies showing contradictory responses after either SG or RYGB ( 83 – 85 ).
Is T1DM a complication?
Hypoglycemia is a relatively frequent complication in T1DM patients undergoing bariatric surgery, reaching an incidence of even 70% ( 30 ). The majority of cases pertains to the early post-operative period; in three different cohorts, the rate of hypoglycemic episodes was 18% ( 32 ), 23% ( 22 ), and 29% ( 28) within the first few days to months after surgery. Altered glucose kinetics, with the rapid delivery of carbohydrates to the jejunum create an imbalance between the higher and earlier glucose excursions and the action of exogenous insulin, while the improvement in insulin sensitivity that follows weight loss renders the previously needed insulin dosages to become excessive. However, no surgical procedure seems to prevent such episodes, despite the fact that sleeve gastrectomy is considered, in general, to be safer due to a more predictable pattern of carbohydrate absorption. Among 32 patients who underwent either biliopancreatic diversion, sleeve gastrectomy or R-n-Y gastric bypass, three patients (9.3%) developed severe hypoglycemic episodes within the first year after surgery, one after each procedure applied ( 23 ). In a study by Faucher et al. ( 31 ), a median of four minor hypoglycemic episodes per week was reported at 6 months after surgery, with more cases being associated with sleeve gastrectomy (median 6 cases) rather than R-n-Y gastric bypass (median 3.5 cases). It is therefore evident that a close monitoring of glucose levels along with careful insulin titration according to the carbohydrate load of each meal is of vital importance in the early post-operative period in order to prevent hypoglycemic episodes regardless of the surgical method used. In this respect, sensor-augmented insulin pump therapy with automated insulin suspension has been related to more stable glycemic control in some patients ( 16, 26 ), however, adequate data regarding the most efficient type of insulin after surgery is not available.
Does bariatric surgery reduce BMI?
Bariatric surgery offers a significant reduction in body mass index (BMI) in patients with obesity and T1DM which is sustained in long term. Czupryniak et al. ( 15) were the first to show a marked improvement in the mean BMI of three women with obesity who underwent RYGB from 42.2 kg/m 2 preoperatively to 33.5 kg/m 2 post-operatively in a follow-up period of ~7 years. After an ~3-years follow-up time, mean reductions in BMI were 11.1, 8.3, and 9.4 kg/m 2 in other cohorts ( 20 – 22 ). In a relatively large cohort of 32 subjects with obesity studied for 4.6 years, the mean percentage of total weight loss (%TWL) at 12 months after surgery was 30.4%, with a slight decrease at 5 years, reaching 28.1% ( 23 ). Cumulatively, a meta-analysis by Chow et al. ( 34 ), including 86 patients in total, showed a reduction in BMI of 13.42 kg/m 2 post-operatively. Another meta-analysis by Ashrafian et al. ( 35 ), including 142 patients in total, showed a mean BMI decrease of 11.04 kg/m 2, in a mean follow-up time of 31.8 months. In general, similar results have been demonstrated by every study on the field regardless of the type of intervention applied, the number of patients or the follow-up period ( 16 – 19, 24 – 32, 36 ).
Is bariatric surgery good for diabetes?
While bariatric surgery has long been considered an effective treatment option for patients with type 2 diabetes, the evidence regarding its benefits on weight loss and the prevention of complications in T1DM patients is scarce, with controversial outcomes.