A Change in BMI
Data was collected from over 22 type 1 diabetes patients with a BMI greater than 35kg/m2, culminating from three bariatric surgery centers in Belgium. Out of the patients studied, 6 had a sleeve gastrectomy, while 16 underwent Roux-en-Y gastric bypass surgery. The BMI, daily insulin dose, and glycemic control were compared using a linear mixed model with a random patient and fixed period effect.
An expected decrease in BMI was shown in all of the 22 patients. Most had a BMI of approximately 39.7 kg/m2 before the surgeries, and the average BMI after the surgeries was 31.4 kg/m2. These findings were in conjunction with a decrease in the total daily insulin dose from 92.5 before the surgeries to 48.0IU after. This reduction was important when it was assessed as insulin dose per kilogram of body weight, such as .08 before the operations and 0.5 after the surgeries. No substantial improvement was noticed when the glycemic control was assessed by A1C of 8.4% before operations and 8.2% after surgeries. There were some adverse events relating to the surgery, including a gastric fistula, an incisional hernia, and a stenosis. No deaths occurred.
Based on the data retrieved after the observed bariatric surgeries, the procedure is safe for patients with Type 1 Diabetes and that weight loss will occur substantially. However, no confirming evidence supports the suggestion that there is any improvement in glycemic control after bariatric surgery has been completed.
There is sufficient evidence to confirm that insulin-sparing effects occur after bariatric surgeries. This is likely to be due to the improvement that takes place in insulin sensitivity after the loss of weight. However, other values within the system dependent upon weight may be resolved.
These might include the incretin effect. The incretins in the body control the glucagon-induced gluconeogenesis levels in patients with diabetes. This mechanism is also explored in clinical studies that allow the GLP-1 agonists to be added to the insulin treatment for type 1 diabetes patients. No testing has been completed to see the effects of a sleeve gastrectomy or roux-en-Y gastric bypass surgery on the incretin. Since sleeve gastrectomy is reported to assist in the absorption of carbohydrates, there may be a solution to the type 1 diabetes issues.
Studies are still being conducted to find out exactly what other ailments can be helped with bariatric surgeries. There seems to be a broad range of weight-related diseases, such as diabetes, that could be further assisted with bariatric surgery. For these ailments, weight loss is a deciding factor in the severity and nature of the problem. With proper studies, it could be determined that the weight loss and the means that are used to achieve it could be useful in curbing some of the symptoms related to the ailments, and in some cases, the issues themselves could be thrown into remission.
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