A Systematic Review and Meta-Analysis of Outcomes for Type 1 Diabetes after Bariatric Surgery

Abstract

Background. The utility of bariatric surgery in type 1 diabetes remains controversial. The aim of the present study is to evaluate glycemic control outcomes in obese patients with type 1 diabetes after bariatric surgery. Methods. A comprehensive search of electronic databases was completed. Inclusion criteria included human adult subjects with BMI ≥35 kg/m2 and a confirmed diagnosis of type 1 diabetes who underwent a bariatric surgical procedure. Results. Thirteen primary studies (86 patients) were included. Subjects had a mean age of 41.16±6.76 years with a mean BMI of 42.50±2.65 kg/m2. There was a marked reduction in BMI postoperatively at 12 months and at study endpoint to 29.55±1.76 kg/m2 (P<0.00001) and 30.63±2.09 kg/m2 (P<0.00001), respectively. Preoperative weighted mean total daily insulin requirement was 98±26 IU/d, which decreased significantly to 36±15 IU/d (P<0.00001) and 42±11 IU/d (P<0.00001) at 12 months and at study endpoint, respectively. An improvement in HbA1c was also seen from 8.46±0.78% preoperatively to 7.95±0.55% (P=0.01) and 8.13±0.86% (P=0.03) at 12 months and at study endpoint, respectively. Conclusion. Bariatric surgery in patients with type 1 diabetes leads to significant reductions in BMI and improvements in glycemic control.