Ichikawa Hidetaka, Imoto Hirofumi, Tanaka Naoki, Musha Hiroaki, Sawada Shojiro, Naitoh Takeshi, Kamei Takashi, Unno Michiaki
Department of Surgery, Tohoku University Graduate School of Medicine, Seiryo-machi, Aoba-ku, Sendai, 980-8574, Japan.
Department of Metabolism and Diabetes, Tohoku University Graduate School of Medicine, 1-1, Seiryo-machi, Aoba-ku, Sendai, 980-8574, Japan.
Surg Case Rep. 2021 Jan 6;7(1):7. doi: 10.1186/s40792-020-00989-5.
Bariatric surgery is effective for the treatment of patients with morbid obesity and type 2 diabetes mellitus (T2DM), for body weight loss and glycemic control. However, in Japan, there has been no previous report of the effectiveness bariatric surgery in a case of morbid obesity associated with acute onset type 1 diabetes mellitus (T1DM), in which pancreatic β-cells were destroyed and endogenous insulin was depleted.
A 36-year-old woman with morbid obesity and T1DM, diagnosed when she was 6 years, was admitted for bariatric surgery. At her first consultation, she had a body weight of 106.7 kg and a body mass index of 42.2 kg/m. Her HbA1c level was 9.0%, with a required daily insulin dose of 75 units. She underwent laparoscopic sleeve gastrectomy. At 1 year after surgery, her body weight had decreased to 81.0 kg and her body mass index to 32.2 kg/m. In addition, her daily required dose of insulin had decreased to 24 units, with an improvement in her HbA1c level to 7.7%.
Although further evidence needs to be accumulated, including long-term outcomes, laparoscopic sleeve gastrectomy may provide an effective treatment for patients with morbid obesity and T1DM for body weight loss, improvement in HbA1c level, and insulin dose reduction.
减重手术对于治疗病态肥胖和2型糖尿病（T2DM）患者的体重减轻和血糖控制是有效的。然而，在日本，此前尚无关于减重手术对与急性起病的1型糖尿病（T1DM）相关的病态肥胖患者有效性的报道，此类患者的胰腺β细胞已被破坏且内源性胰岛素耗竭。
一名36岁患有病态肥胖和T1DM的女性，6岁时被诊断出该病，因减重手术入院。在首次就诊时，她体重106.7千克，体重指数为42.2千克/平方米。她的糖化血红蛋白（HbA1c）水平为9.0%，每日所需胰岛素剂量为75单位。她接受了腹腔镜袖状胃切除术。术后1年，她的体重降至81.0千克，体重指数降至32.2千克/平方米。此外，她每日所需胰岛素剂量降至24单位，HbA1c水平改善至7.7%。
尽管需要积累更多证据，包括长期结果，但腹腔镜袖状胃切除术可能为病态肥胖和T1DM患者提供有效的治疗，以实现体重减轻、HbA1c水平改善和胰岛素剂量减少。
