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Erschienen in: Obesity Surgery 1/2016

01.01.2016 | Review Article

Bariatric Surgery in Type 1 Diabetes Mellitus: A Systematic Review

verfasst von: Kamal K. Mahawar, Nimantha De Alwis, William R. J. Carr, Neil Jennings, Norbert Schroeder, Peter K. Small

Erschienen in: Obesity Surgery | Ausgabe 1/2016

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Abstract

Bariatric surgery is recognised as an effective treatment strategy for obese patients with type 2 diabetes mellitus. An increasing number of patients with type 1 diabetes mellitus also suffer with obesity and obesity-associated comorbidities but the role of bariatric and metabolic surgery in this group of patients is unclear. This systematic review investigates published English language scientific literature to understand the results of bariatric surgery in obese patients with type 1 diabetes mellitus. We found that these patients can experience significant weight loss and comorbidity resolution with bariatric surgery. Though most patients also see a decline in total insulin requirement, glycaemic control remains difficult. Most of the patients reported in literature have undergone gastric bypass but data is insufficient to recommend any particular procedure.
Literatur
2.
Zurück zum Zitat Maraka S, Kudva YC, Kellogg TA, et al. Bariatric surgery and diabetes: implications of type 1 versus insulin-requiring type 2. Obesity (Silver Spring). 2015;23(3):552–7.CrossRef Maraka S, Kudva YC, Kellogg TA, et al. Bariatric surgery and diabetes: implications of type 1 versus insulin-requiring type 2. Obesity (Silver Spring). 2015;23(3):552–7.CrossRef
3.
Zurück zum Zitat Blanco J, Jiménez A, Casamitjana R, et al. Relevance of beta-cell function for improved glycemic control after gastric bypass surgery. Surg Obes Relat Dis. 2014;10(1):9–13. quiz 189–90.PubMedCrossRef Blanco J, Jiménez A, Casamitjana R, et al. Relevance of beta-cell function for improved glycemic control after gastric bypass surgery. Surg Obes Relat Dis. 2014;10(1):9–13. quiz 189–90.PubMedCrossRef
4.
Zurück zum Zitat Chillarón JJ, Benaiges D, Mañé L, et al. Obesity and type 1 diabetes mellitus management. Minerva Endocrinol. 2015;40(1):53–60.PubMed Chillarón JJ, Benaiges D, Mañé L, et al. Obesity and type 1 diabetes mellitus management. Minerva Endocrinol. 2015;40(1):53–60.PubMed
5.
Zurück zum Zitat Polsky S, Ellis SL. Obesity, insulin resistance, and type 1 diabetes mellitus. Curr Opin Endocrinol Diabetes Obes. 2015;22(4):277–82.PubMedCrossRef Polsky S, Ellis SL. Obesity, insulin resistance, and type 1 diabetes mellitus. Curr Opin Endocrinol Diabetes Obes. 2015;22(4):277–82.PubMedCrossRef
6.
Zurück zum Zitat Price SA, Gorelik A, Fourlanos S, et al. Obesity is associated with retinopathy and macrovascular disease in type 1 diabetes. Obes Res Clin Pract. 2014;8(2):e178–82.PubMedCrossRef Price SA, Gorelik A, Fourlanos S, et al. Obesity is associated with retinopathy and macrovascular disease in type 1 diabetes. Obes Res Clin Pract. 2014;8(2):e178–82.PubMedCrossRef
8.
Zurück zum Zitat Komaroff AL. Ask the doctor. I’ve heard bariatric surgery can reduce type 2 diabetes. How about type 1? Harv Health Lett. 2012;38(2):2. Komaroff AL. Ask the doctor. I’ve heard bariatric surgery can reduce type 2 diabetes. How about type 1? Harv Health Lett. 2012;38(2):2.
9.
Zurück zum Zitat Deitel M. Update: why diabetes does not resolve in some patients after bariatric surgery. Obes Surg. 2011;21(6):794–6.PubMedCrossRef Deitel M. Update: why diabetes does not resolve in some patients after bariatric surgery. Obes Surg. 2011;21(6):794–6.PubMedCrossRef
10.
Zurück zum Zitat Czupryniak L, Strzelczyk J, Cypryk K, et al. Gastric bypass surgery in severely obese type 1 diabetic patients. Diabetes Care. 2004;27(10):2561–2.PubMedCrossRef Czupryniak L, Strzelczyk J, Cypryk K, et al. Gastric bypass surgery in severely obese type 1 diabetic patients. Diabetes Care. 2004;27(10):2561–2.PubMedCrossRef
11.
Zurück zum Zitat Czupryniak L, Wiszniewski M, Szymański D, et al. Long-term results of gastric bypass surgery in morbidly obese type 1 diabetes patients. Obes Surg. 2010;20(4):506–8.PubMedCrossRef Czupryniak L, Wiszniewski M, Szymański D, et al. Long-term results of gastric bypass surgery in morbidly obese type 1 diabetes patients. Obes Surg. 2010;20(4):506–8.PubMedCrossRef
12.
Zurück zum Zitat Middelbeek RJ, James-Todd T, Patti ME, et al. Short-term insulin requirements following gastric bypass surgery in severely obese women with type 1 diabetes. Obes Surg. 2014;24(9):1442–6.PubMedPubMedCentralCrossRef Middelbeek RJ, James-Todd T, Patti ME, et al. Short-term insulin requirements following gastric bypass surgery in severely obese women with type 1 diabetes. Obes Surg. 2014;24(9):1442–6.PubMedPubMedCentralCrossRef
13.
Zurück zum Zitat Middelbeek RJ, James-Todd T, Cavallerano JD, et al. Gastric bypass surgery in severely obese women with type 1 diabetes: anthropometric and cardiometabolic effects at 1 and 5 years postsurgery. Diabetes Care. 2015;38(7):e104–5.PubMedCrossRef Middelbeek RJ, James-Todd T, Cavallerano JD, et al. Gastric bypass surgery in severely obese women with type 1 diabetes: anthropometric and cardiometabolic effects at 1 and 5 years postsurgery. Diabetes Care. 2015;38(7):e104–5.PubMedCrossRef
15.
Zurück zum Zitat Breen DM, Rasmussen BA, Kokorovic A, et al. Jejunal nutrient sensing is required for duodenal-jejunal bypass surgery to rapidly lower glucose concentrations in uncontrolled diabetes. Nat Med. 2012;18(6):950–5.PubMedCrossRef Breen DM, Rasmussen BA, Kokorovic A, et al. Jejunal nutrient sensing is required for duodenal-jejunal bypass surgery to rapidly lower glucose concentrations in uncontrolled diabetes. Nat Med. 2012;18(6):950–5.PubMedCrossRef
16.
Zurück zum Zitat Cossu ML, Noya G, Tonolo GC, et al. Duodenal switch without gastric resection: results and observations after 6 years. Obes Surg. 2004;14(10):1354–9.PubMedCrossRef Cossu ML, Noya G, Tonolo GC, et al. Duodenal switch without gastric resection: results and observations after 6 years. Obes Surg. 2004;14(10):1354–9.PubMedCrossRef
17.
Zurück zum Zitat Chuang J, Zeller MH, Inge T, et al. Bariatric surgery for severe obesity in two adolescents with type 1 diabetes. Pediatrics. 2013;132(4):e1031–4.PubMedPubMedCentralCrossRef Chuang J, Zeller MH, Inge T, et al. Bariatric surgery for severe obesity in two adolescents with type 1 diabetes. Pediatrics. 2013;132(4):e1031–4.PubMedPubMedCentralCrossRef
18.
Zurück zum Zitat Serban V, Brink S, Timar B, et al. An increasing incidence of type 1 diabetes mellitus in Romanian children aged 0 to 17 years. J Pediatr Endocrinol Metab. 2015;28(3–4):293–8.PubMed Serban V, Brink S, Timar B, et al. An increasing incidence of type 1 diabetes mellitus in Romanian children aged 0 to 17 years. J Pediatr Endocrinol Metab. 2015;28(3–4):293–8.PubMed
19.
Zurück zum Zitat Derraik JG, Reed PW, Jefferies C, et al. Increasing incidence and age at diagnosis among children with type 1 diabetes mellitus over a 20-year period in Auckland (New Zealand). PLoS One. 2012;7(2), e32640.PubMedPubMedCentralCrossRef Derraik JG, Reed PW, Jefferies C, et al. Increasing incidence and age at diagnosis among children with type 1 diabetes mellitus over a 20-year period in Auckland (New Zealand). PLoS One. 2012;7(2), e32640.PubMedPubMedCentralCrossRef
20.
Zurück zum Zitat Evertsen J, Alemzadeh R, Wang X. Increasing incidence of pediatric type 1 diabetes mellitus in Southeastern Wisconsin: relationship with body weight at diagnosis. PLoS One. 2009;4(9), e6873.PubMedPubMedCentralCrossRef Evertsen J, Alemzadeh R, Wang X. Increasing incidence of pediatric type 1 diabetes mellitus in Southeastern Wisconsin: relationship with body weight at diagnosis. PLoS One. 2009;4(9), e6873.PubMedPubMedCentralCrossRef
21.
Zurück zum Zitat Newhook LA, Grant M, Sloka S, et al. Very high and increasing incidence of type 1 diabetes mellitus in Newfoundland and Labrador. Canada Pediatr Diabetes. 2008;9(3 Pt 2):62–8.PubMedCrossRef Newhook LA, Grant M, Sloka S, et al. Very high and increasing incidence of type 1 diabetes mellitus in Newfoundland and Labrador. Canada Pediatr Diabetes. 2008;9(3 Pt 2):62–8.PubMedCrossRef
22.
Zurück zum Zitat Hussain A, Mahmood H, El-Hasani S. Can Roux-en-Y gastric bypass provide a lifelong solution for diabetes mellitus? Can J Surg. 2009;52(6):E269–75.PubMedPubMedCentral Hussain A, Mahmood H, El-Hasani S. Can Roux-en-Y gastric bypass provide a lifelong solution for diabetes mellitus? Can J Surg. 2009;52(6):E269–75.PubMedPubMedCentral
23.
Zurück zum Zitat Chillarón JJ, Sales MP, Flores-Le-Roux JA, et al. Insulin resistance and hypertension in patients with type 1 diabetes. J Diabetes Complications. 2011;25(4):232–6.PubMedCrossRef Chillarón JJ, Sales MP, Flores-Le-Roux JA, et al. Insulin resistance and hypertension in patients with type 1 diabetes. J Diabetes Complications. 2011;25(4):232–6.PubMedCrossRef
24.
Zurück zum Zitat Chillaron JJ, Flores Le-Roux JA, Benaiges D, et al. Type 1 diabetes, metabolic syndrome and cardiovascular risk. Metabolism. 2014;63(2):181–7.PubMedCrossRef Chillaron JJ, Flores Le-Roux JA, Benaiges D, et al. Type 1 diabetes, metabolic syndrome and cardiovascular risk. Metabolism. 2014;63(2):181–7.PubMedCrossRef
25.
26.
Zurück zum Zitat Shuai X, Tao K, Mori M, et al. Bariatric surgery for metabolic syndrome in obesity. Metab Syndr Relat Disord. 2015;13(4):149–60.PubMedCrossRef Shuai X, Tao K, Mori M, et al. Bariatric surgery for metabolic syndrome in obesity. Metab Syndr Relat Disord. 2015;13(4):149–60.PubMedCrossRef
27.
Zurück zum Zitat Lim EL, Hollingsworth KG, Aribisala BS, et al. Reversal of type 2 diabetes: normalisation of beta cell function in association with decreased pancreas and liver triacylglycerol. Diabetologia. 2011;54(10):2506–14.PubMedPubMedCentralCrossRef Lim EL, Hollingsworth KG, Aribisala BS, et al. Reversal of type 2 diabetes: normalisation of beta cell function in association with decreased pancreas and liver triacylglycerol. Diabetologia. 2011;54(10):2506–14.PubMedPubMedCentralCrossRef
28.
Zurück zum Zitat Raab H, Weiner RA, Frenken M, et al. Obesity and metabolic surgery in type 1 diabetes mellitus. Nutr Hosp. 2013;28 Suppl 2:31–4.PubMed Raab H, Weiner RA, Frenken M, et al. Obesity and metabolic surgery in type 1 diabetes mellitus. Nutr Hosp. 2013;28 Suppl 2:31–4.PubMed
29.
Zurück zum Zitat Manning SB, Pucci A, Batterham RL, et al. Latent autoimmune diabetes in adults presenting as diabetes “recurrence” after bariatric surgery: a case report. Diabetes Care. 2013;36(8), e120.PubMedPubMedCentralCrossRef Manning SB, Pucci A, Batterham RL, et al. Latent autoimmune diabetes in adults presenting as diabetes “recurrence” after bariatric surgery: a case report. Diabetes Care. 2013;36(8), e120.PubMedPubMedCentralCrossRef
30.
Zurück zum Zitat Pozzilli P, Guglielmi C, Pronina E, et al. Double or hybrid diabetes associated with an increase in type 1 and type 2 diabetes in children and youths. Pediatr Diabetes. 2007;8 Suppl 9:88–95.PubMedCrossRef Pozzilli P, Guglielmi C, Pronina E, et al. Double or hybrid diabetes associated with an increase in type 1 and type 2 diabetes in children and youths. Pediatr Diabetes. 2007;8 Suppl 9:88–95.PubMedCrossRef
31.
32.
Zurück zum Zitat Dirksen C, Jacobsen SH, Bojsen-Møller KN, et al. Reduction in cardiovascular risk factors and insulin dose, but no beta-cell regeneration 1 year after Roux-en-Y gastric bypass in an obese patient with type 1 diabetes: a case report. Obes Res Clin Pract. 2013;7(4):e269–74.PubMedCrossRef Dirksen C, Jacobsen SH, Bojsen-Møller KN, et al. Reduction in cardiovascular risk factors and insulin dose, but no beta-cell regeneration 1 year after Roux-en-Y gastric bypass in an obese patient with type 1 diabetes: a case report. Obes Res Clin Pract. 2013;7(4):e269–74.PubMedCrossRef
33.
Zurück zum Zitat Farilla L, Bulotta A, Hirshberg B, et al. Glucagon-like peptide 1 inhibits cell apoptosis and improves glucose responsiveness of freshly isolated human islets. Endocrinology. 2003;144(12):5149–58.PubMedCrossRef Farilla L, Bulotta A, Hirshberg B, et al. Glucagon-like peptide 1 inhibits cell apoptosis and improves glucose responsiveness of freshly isolated human islets. Endocrinology. 2003;144(12):5149–58.PubMedCrossRef
34.
Zurück zum Zitat Farilla L, Hui H, Bertolotto C, et al. Glucagon-like peptide-1 promotes islet cell growth and inhibits apoptosis in Zucker diabetic rats. Endocrinology. 2002;143(11):4397–408.PubMedCrossRef Farilla L, Hui H, Bertolotto C, et al. Glucagon-like peptide-1 promotes islet cell growth and inhibits apoptosis in Zucker diabetic rats. Endocrinology. 2002;143(11):4397–408.PubMedCrossRef
35.
Zurück zum Zitat Meier JJ, Bhushan A, Butler AE, et al. Sustained beta cell apoptosis in patients with long-standing type 1 diabetes: indirect evidence for islet regeneration? Diabetologia. 2005;48(11):2221–8.PubMedCrossRef Meier JJ, Bhushan A, Butler AE, et al. Sustained beta cell apoptosis in patients with long-standing type 1 diabetes: indirect evidence for islet regeneration? Diabetologia. 2005;48(11):2221–8.PubMedCrossRef
36.
Zurück zum Zitat Hari Kumar KV, Shaikh A, Prusty P. Addition of exenatide or sitagliptin to insulin in new onset type 1 diabetes: a randomized, open label study. Diabetes Res Clin Pract. 2013;100(2):e55–8.PubMedCrossRef Hari Kumar KV, Shaikh A, Prusty P. Addition of exenatide or sitagliptin to insulin in new onset type 1 diabetes: a randomized, open label study. Diabetes Res Clin Pract. 2013;100(2):e55–8.PubMedCrossRef
37.
Zurück zum Zitat Traina AN, Lull ME, Hui AC, et al. Once-weekly exenatide as adjunct treatment of type 1 diabetes mellitus in patients receiving continuous subcutaneous insulin infusion therapy. Can J Diabetes. 2014;38(4):269–72.PubMedCrossRef Traina AN, Lull ME, Hui AC, et al. Once-weekly exenatide as adjunct treatment of type 1 diabetes mellitus in patients receiving continuous subcutaneous insulin infusion therapy. Can J Diabetes. 2014;38(4):269–72.PubMedCrossRef
38.
Zurück zum Zitat Lannoo M, Dillemans B, Van Nieuwenhove Y, et al. Bariatric surgery induces weight loss but does not improve glycemic control in patients with type 1 diabetes. Diabetes Care. 2014;37(8):e173–4.PubMedCrossRef Lannoo M, Dillemans B, Van Nieuwenhove Y, et al. Bariatric surgery induces weight loss but does not improve glycemic control in patients with type 1 diabetes. Diabetes Care. 2014;37(8):e173–4.PubMedCrossRef
39.
Zurück zum Zitat Pories WJ, Swanson MS, MacDonald KG, et al. Who would have thought it? An operation proves to be the most effective therapy for adult-onset diabetes mellitus. Ann Surg. 1995;222(3):339–50. discussion 350–2.PubMedPubMedCentralCrossRef Pories WJ, Swanson MS, MacDonald KG, et al. Who would have thought it? An operation proves to be the most effective therapy for adult-onset diabetes mellitus. Ann Surg. 1995;222(3):339–50. discussion 350–2.PubMedPubMedCentralCrossRef
40.
Zurück zum Zitat Nambam B, Aggarwal S, Jain A. Latent autoimmune diabetes in adults: a distinct but heterogenous clinical entity. World J Diabetes. 2010;1(4):111–5.PubMedPubMedCentralCrossRef Nambam B, Aggarwal S, Jain A. Latent autoimmune diabetes in adults: a distinct but heterogenous clinical entity. World J Diabetes. 2010;1(4):111–5.PubMedPubMedCentralCrossRef
41.
Zurück zum Zitat Fourlanos S, Dotta F, Greenbaum CJ, et al. Latent autoimmune diabetes in adults (LADA) should be less latent. Diabetologia. 2005;48(11):2206–12.PubMedCrossRef Fourlanos S, Dotta F, Greenbaum CJ, et al. Latent autoimmune diabetes in adults (LADA) should be less latent. Diabetologia. 2005;48(11):2206–12.PubMedCrossRef
42.
Zurück zum Zitat Baskota A, Li S, Dhakal N, et al. Bariatric surgery for type 2 diabetes mellitus in patients with BMI <30 kg/m2: a systematic review and meta-analysis. PLoS One. 2015;10(7), e0132335.PubMedPubMedCentralCrossRef Baskota A, Li S, Dhakal N, et al. Bariatric surgery for type 2 diabetes mellitus in patients with BMI <30 kg/m2: a systematic review and meta-analysis. PLoS One. 2015;10(7), e0132335.PubMedPubMedCentralCrossRef
43.
Zurück zum Zitat Ngiam KY, Lee WJ, Lee YC, et al. Efficacy of metabolic surgery on HbA1c decrease in type 2 diabetes mellitus patients with BMI <3558—a review. Obes Surg. 2014;24(1):148–58.PubMedCrossRef Ngiam KY, Lee WJ, Lee YC, et al. Efficacy of metabolic surgery on HbA1c decrease in type 2 diabetes mellitus patients with BMI <3558—a review. Obes Surg. 2014;24(1):148–58.PubMedCrossRef
45.
Zurück zum Zitat Fuertes-Zamorano N, Sánchez-Pernaute A, Torres García AJ, et al. Bariatric surgery in type 1 diabetes mellitus; long-term experience in two cases. Nutr Hosp. 2013;28(4):1333–6.PubMed Fuertes-Zamorano N, Sánchez-Pernaute A, Torres García AJ, et al. Bariatric surgery in type 1 diabetes mellitus; long-term experience in two cases. Nutr Hosp. 2013;28(4):1333–6.PubMed
46.
Zurück zum Zitat Brethauer SA, Aminian A, Rosenthal RJ, et al. Bariatric surgery improves the metabolic profile of morbidly obese patients with type 1 diabetes. Diabetes Care. 2014;37(3):e51–2.PubMedPubMedCentralCrossRef Brethauer SA, Aminian A, Rosenthal RJ, et al. Bariatric surgery improves the metabolic profile of morbidly obese patients with type 1 diabetes. Diabetes Care. 2014;37(3):e51–2.PubMedPubMedCentralCrossRef
47.
Zurück zum Zitat Reyes Garcia R, Romero Muñoz M, Galbis Verdú H. Bariatric surgery in type 1 diabetes. Endocrinol Nutr. 2013;60(1):46–7.PubMedCrossRef Reyes Garcia R, Romero Muñoz M, Galbis Verdú H. Bariatric surgery in type 1 diabetes. Endocrinol Nutr. 2013;60(1):46–7.PubMedCrossRef
48.
Zurück zum Zitat Mendez CE, Tanenberg RJ, Pories W. Outcomes of Roux-en-Y gastric bypass surgery for severely obese patients with type 1 diabetes: a case series report. Diabetes Metab Syndr Obes. 2010;3:281–3.PubMedPubMedCentral Mendez CE, Tanenberg RJ, Pories W. Outcomes of Roux-en-Y gastric bypass surgery for severely obese patients with type 1 diabetes: a case series report. Diabetes Metab Syndr Obes. 2010;3:281–3.PubMedPubMedCentral
49.
Zurück zum Zitat Ziemiański P, Lisik W, Marszałek RJ, et al. Improvement of graft function following Roux-en-Y gastric bypass surgery in a morbidly obese kidney recipient: a case report and literature review. Ann Transplant. 2014;19:639–42.PubMedCrossRef Ziemiański P, Lisik W, Marszałek RJ, et al. Improvement of graft function following Roux-en-Y gastric bypass surgery in a morbidly obese kidney recipient: a case report and literature review. Ann Transplant. 2014;19:639–42.PubMedCrossRef
Metadaten
Titel
Bariatric Surgery in Type 1 Diabetes Mellitus: A Systematic Review
verfasst von
Kamal K. Mahawar
Nimantha De Alwis
William R. J. Carr
Neil Jennings
Norbert Schroeder
Peter K. Small
Publikationsdatum
01.01.2016
Verlag
Springer US
Erschienen in
Obesity Surgery / Ausgabe 1/2016
Print ISSN: 0960-8923
Elektronische ISSN: 1708-0428
DOI
https://doi.org/10.1007/s11695-015-1924-z

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