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Type 1 diabetes mellitus and bariatric surgery: a systematic review and meta-analysis

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Title: Type 1 diabetes mellitus and bariatric surgery: a systematic review and meta-analysis
Authors: Ashrafian, H
Harling, L
Toma, T
Athanasiou, C
Nikiteas, N
Efthimiou, E
Darzi, A
Athanasiou, T
Item Type: Journal Article
Abstract: Type 1 diabetes mellitus (T1DM) has a rising global prevalence. Although it is vastly outnumbered by type 2 diabetes mellitus rates, it remains a persistent worldwide source of morbidity and mortality. Increasingly, its sufferers are afflicted by obesity and its complications. The objective of the study is to quantify the effects of bariatric surgery on T1DM by appraising the primary outcomes of glycosylated haemoglobin (HbA1c), insulin requirements and body mass index (BMI). Secondary outcomes included blood pressure, triglycerides and cholesterol biochemistry.A systematic review of studies reporting pre-operative and post-operative outcomes in T1DM patients undergoing bariatric surgery was done. Data were meta-analysed using random effects modelling. Subgroup analysis and quality scoring were assessed.Bariatric surgery in obese T1DM patients is associated with a significant reduction in insulin requirement (-48.95 units, 95 % CI of -56.27, -41.62), insulin requirement per kilogramme (-0.391, 95 % CI of -0.51, -0.27), HbA1c (-0.933, 95 % CI of -1.604, -0.262) and BMI (-11.04 kg/m(2), 95 % CI of -13.49, -8.59). Surgery is also associated with a statistically significant reduction in systolic and diastolic blood pressure and a significant beneficial rise in HDL. Heterogeneity in these results was high, and study quality was low overall.Bariatric surgery in obese T1DM patients is associated with a significant improvement in insulin requirement and a significant though modest effect on HbA1c. These early results require further substantiation with future studies focusing on higher levels of evidence. This may offer a deeper understanding of diabetogenesis and can contribute to better selection and stratification of diabetic patients for metabolic surgery and future metabolic treatment strategies.
Issue Date: 22-Dec-2015
Date of Acceptance: 22-Dec-2015
URI: http://hdl.handle.net/10044/1/31620
DOI: https://dx.doi.org/10.1007/s11695-015-1999-6
ISSN: 1708-0428
Publisher: Springer Verlag
Start Page: 1697
End Page: 1704
Journal / Book Title: Obesity Surgery
Volume: 26
Issue: 8
Copyright Statement: © The Author(s) 2015. This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.
Sponsor/Funder: Wellcome Trust
National Institute for Health Research
Funder's Grant Number: 083662/Z/07/Z
DH PO:481818
Keywords: Bariatric surgery
Body mass index
Diabetes
Glycosylated haemoglobin
HbA1c
Intervention
Metabolic surgery
Surgery
Type 1 diabetes mellitus
Type 2 diabetes mellitus
Weight loss
1103 Clinical Sciences
1117 Public Health And Health Services
Publication Status: Published
Appears in Collections:Division of Surgery
Faculty of Medicine



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