Department of Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
Department of Molecular and Clinical Medicine, University of Gothenburg, Gothenburg, Sweden.
Diabetes Care. 2020 Dec;43(12):3079-3085. doi: 10.2337/dc20-0388. Epub 2020 Oct 6.
To study the potential long-term benefits and possible complications of bariatric surgery in patients with type 1 diabetes (T1D).
In this register-based nationwide cohort study, we compared individuals with T1D and obesity who underwent Roux-en-Y gastric bypass (RYGB) surgery with patients with T1D and obesity matched for age, sex, BMI, and calendar time that did not undergo surgery. By linking the Swedish National Diabetes Register and Scandinavian Obesity Surgery Registry study individuals were included between 2007 and 2013. Outcomes examined included all-cause mortality, cardiovascular disease, stroke, heart failure, and hospitalization for serious hypo- or hyperglycemic events, amputation, psychiatric disorders, changes in kidney function, and substance abuse.
We identified 387 individuals who had undergone RYGB and 387 control patients. Follow-up for hospitalization was up to 9 years. Analysis showed lower risk for cardiovascular disease (hazard ratio [HR] 0.43; 95% CI 0.20-0.9), cardiovascular death (HR 0.15; 95% CI 0.03-0.68), hospitalization for heart failure (HR 0.32; 95% CI 0.15-0.67), and stroke (HR 0.18; 95% CI 0.04-0.82) for the RYGB group. There was a higher risk for serious hyperglycemic events (HR 1.99; 95% CI 1.07-3.72) and substance abuse (HR 3.71; 95% CI 1.03-3.29) after surgery.
This observational study suggests bariatric surgery may yield similar benefits on risk for cardiovascular outcomes and mortality in patients with T1D and obesity as for patients with type 2 diabetes. However, some potential serious adverse effects suggest need for careful monitoring of such patients after surgery.
研究肥胖的 1 型糖尿病（T1D）患者接受减重手术的潜在长期获益和可能的并发症。
在这项基于注册的全国性队列研究中，我们比较了接受 Roux-en-Y 胃旁路术（RYGB）的 T1D 肥胖患者与未接受手术的年龄、性别、BMI 和时间匹配的 T1D 肥胖患者。通过链接瑞典国家糖尿病登记处和斯堪的纳维亚肥胖手术登记处，我们在 2007 年至 2013 年间纳入了研究个体。研究的结果包括全因死亡率、心血管疾病、卒中和心力衰竭以及严重低血糖或高血糖事件住院、截肢、精神疾病、肾功能变化和药物滥用。
我们确定了 387 例接受 RYGB 的患者和 387 例对照患者。住院随访时间最长达 9 年。分析显示，心血管疾病（风险比 [HR] 0.43；95%置信区间 0.20-0.9）、心血管死亡（HR 0.15；95%置信区间 0.03-0.68）、心力衰竭住院（HR 0.32；95%置信区间 0.15-0.67）和卒中等风险降低中风（HR 0.18；95%置信区间 0.04-0.82）对于 RYGB 组。手术后严重高血糖事件（HR 1.99；95%置信区间 1.07-3.72）和药物滥用（HR 3.71；95%置信区间 1.03-3.29）的风险更高。
这项观察性研究表明，对于肥胖的 T1D 患者，减重手术可能与 2 型糖尿病患者一样，对心血管结局和死亡率的风险具有相似的获益。然而，一些潜在的严重不良事件表明，术后需要对这些患者进行仔细监测。
