Type 1 diabetes patients may be good candidates for bariatric surgery

Bariatric surgery, a study shows, is beneficial for patients with type 1 diabetes, but without chance of remission.

"Certainly we don't expect any remission, but what we see is improved control," Dr. Stacy Brethauer told MedPage Today.

For instance, the procedure reduces the amount of insulin patients require, while also improving cardiovascular risk factors like hypertension (improvements seen in 71 percent of patients), LDL (P=0.02), HDL (P=0.001) and triglycerides (P=0.007), results show.

Bariatric surgery is commonly used in type 2 diabetes patients because, unlike type 1 diabetes, they go into remission. So Brethauer's team at the Cleveland Clinic conducted a small case series of 10 morbidly obese patients with poorly controlled type 1 disease who had a laparoscopic procedure - gastric bypass, gastric banding or sleeve gastrectomy. These patients had type 1 diabetes for a median of 22 years and a mean body mass index (BMI) of 42 kg/m2.

Over three years later, the researchers followed up with participants and found that their BMI was reduced to a mean of 27 kg/m2 and everyone, excluding one patient, lost more than 60 percent of their body weight.

Brethauer explained that though bariatric surgery does have weight loss benefits, it is effective in managing type 1 diabetes.

"We hope this raises awareness that type 1 diabetes is not a contraindication to having this weight-loss procedure ... even though these are patients who've already had cardiac events," he clarified. "These are fairly sick patients with micro- and macrovascular disease, yet we're able to do these operations safely even in this high-risk group."

While Dr. Mitch Roslin, a bariatric surgeon at Lenox Hill Hospital in New York City, notes the surgery's success, he nevertheless remains skeptical.

"Whether this is a direct effect of the operations, or secondary to eating less, is not known," he said.