Landau Zohar, Kowen-Sandbank Galit, Jakubowicz Daniela, Raziel Asnat, Sakran Nasser, Zaslavsky-Paltiel Inna, Lerner-Geva Liat, Pinhas-Hamiel Orit
Pediatric Endocrinology Unit, Wolfson Medical Center, 65 Halochamim Street, Holon, 58100, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Maccabi Juvenile Diabetes Center, Raanana, Israel.
Maccabi Juvenile Diabetes Center, Raanana, Israel.
Ther Adv Endocrinol Metab. 2019 Jan 30;10:2042018818822207. doi: 10.1177/2042018818822207. eCollection 2019.
We examined short and long-term outcomes of bariatric surgery in patients with obesity and type 1 diabetes mellitus (T1DM).
We reviewed the records of all adults insured by Maccabi Healthcare Services during 2010 -2015, with body mass index (BMI) ⩾30 kg/m2 and T1DM; and compared weight reduction and glucose control according to the performance of bariatric surgery. BMI and glycated hemoglobin (HbA1c) levels were extracted for baseline and every 6 months, for a mean 3.5 years.
Of 52 patients, 26(50%) underwent bariatric surgery. Those who underwent surgery were more often female and with a longer duration of diabetes. Immediately postoperative, 4(15%) developed diabetic ketoacidosis, while 6(23%) experienced severe hypoglycemic episodes. The mean BMI decreased among surgery patients: from 39.5±4.4 to 30.1±5.0 kg/m2 ( < 0.0001); and increased among those who did not undergo surgery: from 33.6±3.9 to 35.1±4.4 kg/m2 ( = 0.49). The mean HbA1c level decreased during the first 6 months postoperative: from 8.5±0.9% to 7.9±0.9%; however, at the end of follow-up, was similar to baseline, 8.6±2.0% (p = 0.87). For patients who did not undergo surgery, the mean HbA1c increased from 7.9±1.9% to 8.6±1.5% ( = 0.09).
Among individuals with obesity and T1DM, weight loss was successful after bariatric surgery, but glucose control did not improve. The postoperative risks of diabetic ketoacidosis and severe hypoglycemic episodes should be considering when performing bariatric surgery in this population.
我们研究了肥胖症合并1型糖尿病（T1DM）患者接受减肥手术后的短期和长期结果。
我们回顾了2010 - 2015年期间由Maccabi医疗服务公司承保的所有成年人的记录，这些人体重指数（BMI）⩾30 kg/m²且患有T1DM；并根据减肥手术的实施情况比较体重减轻和血糖控制情况。提取BMI和糖化血红蛋白（HbA1c）水平用于基线以及每6个月一次的数据，平均为期3.5年。
52例患者中，26例（50%）接受了减肥手术。接受手术的患者女性居多且糖尿病病程更长。术后即刻，4例（15%）发生糖尿病酮症酸中毒，6例（23%）经历严重低血糖发作。手术患者的平均BMI下降：从39.5±4.4降至30.1±5.0 kg/m²（<0.0001）；未接受手术的患者平均BMI上升：从33.6±3.9升至35.1±4.4 kg/m²（=0.49）。术后前6个月平均HbA1c水平下降：从8.5±0.9%降至7.9±0.9%；然而，随访结束时，与基线相似，为8.6±2.0%（p = 0.87）。未接受手术的患者，平均HbA1c从7.9±1.9%升至8.6±1.5%（=0.09）。
在肥胖症合并T1DM的个体中，减肥手术后体重减轻成功，但血糖控制未改善。在该人群中进行减肥手术时应考虑糖尿病酮症酸中毒和严重低血糖发作的术后风险。
