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Glycemic Control in Type 1 Diabetes Patients Not Improved by Bariatric Surgery

Diabetes equipmentA Change in BMI

Data was conducted from over 22 type 1 diabetes patients with a BMI of greater than 35kg/m2 culminating from three bariatric surgery centers located in Belgian. Out of the patients studied, 6 of them had a sleeve gastrectomy while 16 of them underwent Roux-en-Y gastric bypass surgery. Using a linear mixed model with a random patient and fixed period effect, the BMI, daily insulin dose and glycemic control was compared.

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 were 31.4 kg/m2. These findings were in conjunction with a decrease in the total daily dose of insulin from 92.5 before the surgeries to 48.0IU after the surgeries. This reduction kept its importance when it was assessed as insulin dose per kilogram of body weight such as .08 before the operations and 0.5 after the surgeries. There was not substantial improvement 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.

It has been concluded that based on the data retrieved after the observed bariatric surgeries that 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 do occur after the bariatric surgeries. This is likely to be due to the improvement that takes place in insulin sensitivity after the loss of the weight. However, other values within the system that are dependent upon weight may be resolved.

These might include the incretin effect. The incretins in the body control the glucagon-induced gluconeogenesis levels in those patients that have 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. There has been no testing completed to done 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, it is possible that there is a solution to the type 1 diabetes issues.

There are still studied being conducted to find out exactly what other ailments can be helped with the use of 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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