title: Outcome of bariatric surgery in patients with type 1 diabetes mellitus: our experience and review of the literature.
abstract: The beneficial effect of bariatric surgery (BS) in type 2 diabetes mellitus patients is well established. Conversely, little is known about the efficacy of BS in type 1 diabetes mellitus (T1DM) patients, despite the increasing prevalence of obesity in this population.
  
  
  
  A retrospective review was carried out on a prospectively collected bariatric surgery registry of all patients undergoing BS at two university hospitals between 2010 and 2015. Patients with T1DM were identified, and detailed chart reviews were obtained.
  
  
  
  In this time period, we operated on thirteen patients with T1DM. Eight were female (61.5 %). Median age at time of surgery was 38 ± 8.3 (range 28-53) years. The procedures performed were laparoscopic sleeve gastrectomy (n = 10) and laparoscopic Roux-en-Y gastric bypass (n = 3). On median postoperative follow-up of 24 (range 2.5-51) months, mean body mass index significantly decreased from 39.9 ± 4.1 to 30.1 ± 3.9 kg/m2(P < 0.0001) and insulin requirements were significantly reduced from 83.7 ± 40.4 to 45.7 ± 33.1 U/day (P < 0.01). However, there was no significant change in glycemic control assessed by HbA1C (P = 0.2). During the first months following surgery, three patients (21.4 %) experienced diabetic ketoacidosis, and four patients (28.6 %) reported more frequent episodes of hypoglycemia.
  
  
  
  Bariatric surgery in morbidly obese T1DM patients is an effective method for weight loss, leading to a remarkable improvement in insulin requirements. Larger prospective studies are still needed to confirm these findings, assess long-term effects of BS and better delineate its risk-to-benefit ratio in this growing population of morbidly obese patients with T1DM.
authors.affiliation: Department of Surgery, Hadassah-Hebrew University Medical Center, Ein-kerem Campus, POB 12000, 91120, Jerusalem, Israel. amichaimd@gmail.com.
authors.forename: Amihai
authors.initials: A
authors.lastname: Rottenstreich
authors.affiliation: Department of Surgery, Rabin Medical Center, Beilinson Campus, Petach Tiqva, Israel.
authors.forename: Andrei
authors.initials: A
authors.lastname: Keidar
authors.affiliation: Department of Surgery, Hadassah-Hebrew University Medical Center, Ein-kerem Campus, POB 12000, 91120, Jerusalem, Israel.
authors.forename: Jonathan B
authors.initials: JB
authors.lastname: Yuval
authors.affiliation: Department of Surgery, Hadassah-Hebrew University Medical Center, Ein-kerem Campus, POB 12000, 91120, Jerusalem, Israel.
authors.forename: Mahmoud
authors.initials: M
authors.lastname: Abu-Gazala
authors.affiliation: Department of Surgery, Hadassah-Hebrew University Medical Center, Ein-kerem Campus, POB 12000, 91120, Jerusalem, Israel.
authors.forename: Abed
authors.initials: A
authors.lastname: Khalaileh
authors.affiliation: Department of Surgery, Hadassah-Hebrew University Medical Center, Ein-kerem Campus, POB 12000, 91120, Jerusalem, Israel.
authors.forename: Ram
authors.initials: R
authors.lastname: Elazary
mesh_terms: D000328:Adult; D050110:Bariatric Surgery / Q000379:methods; D003922:Diabetes Mellitus, Type 1 / Q000150:complications*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000150:complications / Q000601:surgery*; D012042:Registries; D012189:Retrospective Studies; D016896:Treatment Outcome; D015431:Weight Loss
keywords: Bariatric surgery; Glycemic control; Insulin requirements; Obesity; T1DM; Weight loss