Recent data show that ∼50% of patients with type 1 diabetes (T1D) are overweight or obese. Few patients with T1D and obesity resort to bariatric surgery (BS) for weight reduction and possible improvement in glycemic control. However, previous studies reported conflicting long-term effects of BS on glycemic control and other cardiovascular risk factors in this population. Meanwhile, no previous study compared BS outcomes in patients with T1D to a matched cohort receiving standard care.
In our electronic health records, we identified 20 patients with T1D and obesity who underwent BS and received diabetes care at our center (baseline mean age 41±10 years, T1D duration 24±12 years, all female, HbA1c 8.4±1.3%, BMI 43.6±6.3 kg/m2, weight 119.2±18.0 kg, systolic BP 128±11 mmHg, diastolic BP 75±8 mmHg, LDL-C 104±34 mg/dL, HDL-C 59±18 mg/dL, triglycerides 121±61mg/dL). We matched them in a 1:1 ratio with a similar cohort of patients who received standard diabetes care at the same center (baseline mean age 43±12 years, T1D duration 22±11 years, HbA1c 8.4±1.0%, BMI 43.9±6.3 kg/m2, weight 116.1±19.3 kg, systolic BP 123±17 mmHg, diastolic BP 71±9 mmHg, LDL-C 81±22 mg/dL, HDL-C 57±20 mg/dL, triglycerides 103±62mg/dL). T1D was confirmed based on the presence of antibodies, history of DKA and clinical criteria. There were no differences between cohorts at baseline, except that more patients used insulin pump therapy in the BS cohort (55% vs. 35%, p<0.05).
At 3 years, body weight changed by -33.5±2.6 kg (-28.1±2.2%) in the BS cohort and by +2.6±2.8 kg (+2.2±2.4%) in the matched cohort (p<0.0001). However, HbA1c, BP and LDL-C did not change from baseline in both cohorts. HDL-C increased and triglycerides decreased in the BS cohort in comparison to the matched cohort (p<0.for both).
These results show that despite significant reduction in body weight and improvements in HDL-C and triglyceride levels, bariatric surgery has no long-term impact on glycemic control, BP and LDL-C in patients with T1D and obesity.
A. Mottalib: None. K. Alsibai: None. S. Tomah: None. T. Elseaidy: None. J.R. Holley-Cuthrell: None. R. Middelbeek: None. N. Mahmoud: None. S. Ashrafzadeh: None. F.M. Brown: None. O. Hamdy: Research Support; Self; Abbott. Advisory Panel; Self; AstraZeneca. Consultant; Self; Merck & Co., Inc.. Research Support; Self; Novo Nordisk A/S. Stock/Shareholder; Self; Healthimation, LLC.. Consultant; Self; Sanofi-Aventis.