While bariatric surgery does nothing to directly improve type 1 diabetes, it can work indirectly through moderate obesity by increasing insulin sensitivity by reducing the total insulin needs of patients with type 1 diabetes based on a single center. , A review chart of 38 US patients.
Two years after bariatric surgery, these 38 patients were diagnosed with type 1 diabetes with a mean body mass index of 43 kg / m2: “Before surgery, the average daily requirement of insulin was reduced by almost half, from 118 units per day to 60 units, which is a significant decrease,” said Brian D. Surgery.
Another measure of this effect showed that the percentage of patients who required more than one drug to treat their hyperglycaemia dropped from 66% before surgery to 52% two years after surgery, a change that was not statistically significant, says a bariatric surgeon. Dessife. Geisinger Medical Center Danville, Pa.
Suitable for patients “Double diabetes ‘
These results “provide good evidence for this.” [using] “Bariatric surgery” in both obese and people with type 1 diabetes, “he concluded. This includes people what Dessify calls “double diabetes”, meaning that they do not produce endogenous insulin, as they are “resistant to the effects of exogenous insulin” and therefore have the characteristics of type 2 diabetes.
“This is a really important study,” said Dr. Ali Aminyan, director of the Clearland Clinic’s Barrier Metabolic Institute. “The main goal of bariatric surgery for people with type 1 diabetes is to lose weight and improve the follow-up associated with obesity. “Patients with type 2 diabetes can be candidates for bariatric surgery, regardless of their weight,” said Aminyan. to report
“The goal of bariatric surgery for people with type 1 diabetes is to stimulate their sensitivity to the exogenous insulin they receive,” said Julie Uli Kim, a bariatric surgeon at Waltham University, Massachusetts, discussing the second at Jupiter Hospital. . Patients with “Double Diabetes” are probably a subset of patients [with type 1 diabetes] who may benefit more from bariatric surgery. ”
Use of gastric lavage to avoid diabetic ketoacidosis
“At the Cleveland Clinic, we consider gastrectomy the preferred procedure for patients with type 1 diabetes or type 2 insulin insufficiency, if the patient has absolutely no contraindications, and these patients undergo any surgery, including For bariatric surgery. ” Patients with insulin deficiency “require intensive diabetes և preoperative insulin administration to reduce the risk of developing diabetic ketoacidosis.” he said.
According to Dessify, 33 patients underwent gastric bypass and 5 underwent gastrectomy. The decision to use bypass usually came from its “marginal” improvement in weight loss over the general’s preference procedure և in Geisinger. Desif added that he has not yet conducted a comprehensive assessment of the complications of diabetic ketoacidosis among the patients he reports.
Those 38 patients underwent bariatric surgery between 2002 and 2019, which is less than 1% of the total 4,549 bariatric surgeries performed at Geisinger during that period. The average of 38 patients with type 1 diabetes was 41 years old, 33 (87%) were women and 37 (97%) were white. Dessify և partners undertook this review “to help provide evidence of obesity օգտագործ for bariatric surgery in people with type 1 diabetes,” he said.
Dessify, Aminyan և Kim had no revelations.
This article originally appeared on MDedge.com, part of the Medscape Professional Network.