Bariatric surgery has mixed effects on patients with type 1 diabetes

Obese patients with type 1 diabetes mellitus (T1DM) who undergo gastric bypass surgery have a reduced risk of death due to cardiovascular disease and stroke, but an increased risk of diabetic ketoacidosis (DKA) compared with their peers who do not undergo bariatric surgery. surgery. This conclusion was reached by experts from Sahlgrenska University Hospital in Sweden. The study results were presented at the annual meeting of the European Association for the Study of Diabetes (EASD 2019) September 16–20.

The researchers used the Swedish National Diabetes Registry and the Scandinavian Bariatric Surgery Registry to obtain data on 387 adults (mean age 41.65 years; 77% women; mean body mass index (BMI) 40.77 kg/m2) with T1DM who underwent gastric bypass with Roux-en-Y gastrojejunostomy. This information was then compared with 387 adults (mean age 41.15 years; 89.1% women; mean BMI 39.39 kg/m2) with T1DM who did not undergo such surgery. Deaths from all causes and from cardiovascular disease, cardiovascular disease (CVD), hypoglycemia, and hyperglycemia from 2007 to 2013 were identified from hospital discharge data and causes of death reported in registries. The mean follow-up period was 5.8 years for all-cause death and 4.7 years for all other outcomes.

It was found that patients who underwent gastric bypass had a reduced risk of death from cardiovascular pathologies by 85%, heart failure (HF) by 68%, stroke by 82%, and CVD by 57%. However, the differences in death from all causes, myocardial infarction, and atrial fibrillation (AF) in both groups were not statistically significant. However, the researchers found that patients undergoing bariatric surgery had a 2-fold increased risk of a serious hyperglycemic event (including DKA) leading to hospitalization.

The experts concluded that patients with T1DM who are considering gastric bypass surgery should be informed of the controversial consequences of the procedure. In addition, the need for further research taking into account factors not considered in this analysis was noted. For example, the number of participants who used insulin pumps and the number who preferred continuous glucose monitoring (CGM) should be examined; whether patients experienced postoperative complications such as malnutrition or not.

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