Gastric Bypass and Type 1 Diabetes Mellitus

Gastric bypass for type 1 diabetes is rarely performed. Although it is a well-established treatment option for people with type 2 diabetes.

However, obese people with type 1 diabetes can also go for this treatment as it greatly reduces the risk of other complications that are associated with type 1 diabetes.

Obesity and Type 1 Diabetes:

Obesity has been linked to the onset of chronic metabolic diseases such as type 2 diabetes mellitus (T2DM), hypertension, and hyperlipidemia.

In individuals with type 1 diabetes, the prevalence of obesity has alarmingly increased in recent years, with poorly understood mechanisms resulting in the development of insulin resistance and cardiometabolic problems.

Type 1 Diabetes is linked to major long-term consequences that impact the cardiovascular system, eyes, kidneys, and nervous system as well as predispose to specific infections, which can result in noticeably higher mortality rates compared to non-diabetics.

Overweight and obese Type 1 diabetic are more at risk of developing diabetic eye disease and other complications [Ref].

In predisposed young people, obesity and insulin resistance may hasten the onset of T1DM [ref].

However, managing T1DM in those who are extremely obese can be difficult since aggressive insulin therapy may have negative anabolic effects on body weight, which worsens insulin resistance [Ref].

Importantly, research suggests that there is a link between metabolic syndrome and obesity and the progression of both microvascular and macrovascular problems in people with T1D.

Bariatric surgical procedures have positive effects on elements of metabolic syndrome.

It reduces the risk of hyperglycemia, dyslipidemia, hypertension, and inflammation, in addition to achieving significant and long-lasting weight loss.

Surgical Techniques for Type 1 Diabetes

Patients with Type 1 diabetes may undergo all four extensively used bariatric operations:

1. Biliopancreatic diversion with duodenal switch.
2. Adjustable gastric banding.
3. Sleeve gastrectomy.
4. Roux-en-Y gastric bypass.

In one study,  Roux-en-Y gastric bypass was the most popular treatment among 65% of the participants.

Loop gastric bypass (mini-gastric bypass) [Ref] and single-anastomosis duodeno-ileal bypass were other treatments that were documented [Ref].

Diversionary bariatric procedure

Diversionary bariatric surgeries are more effective than non-diversionary procedures. They improve the metabolic health of Type 2 diabetes patients, as evidenced by greater weight loss and weight-independent effects.

With a risk/benefit profile that falls between strictly restrictive (gastric banding) and malabsorptive (duodenal switch) surgeries, gastric bypass offers a therapy option for Type 1 diabetes patients at an acceptable risk [Ref].

Sleeve gastrectomy for Type 1 Diabetes:

A  recent surgical treatment, sleeve gastrectomy offers weight loss, metabolic benefits, and surgical risks in between procedures.

In patients with Type 1 diabetes, sleeve gastrectomy may be an effective choice for postoperative glycemic management and lowering the risk of hypoglycemia since it is thought to result in a more predictable absorption of carbs and fat-soluble nutrients [Ref].

Gastric Bypass and Type 1 Diabetes Associated Comorbid Medical Conditions:

Most obesity-related comorbidities, including hypertension, dyslipidemia, sleep apnea, GERD, liver steatosis, and musculoskeletal issues, are resolved or improved after bariatric surgery.

Severely obese patients with T1DM can benefit from the same favorable effects on obesity-related comorbidities.

Studies showed improvements in lipid profiles and blood pressure of Type 1 diabetes patients who underwent weight loss surgery [Ref].

In a side-by-side study, the remission rates of hypertension and dyslipidemia were comparable in both T1DM and T2DM patients after weight loss surgery.

A few studies also found evidence that surgery improved patients’ quality of life, retinopathy, renal function, microalbuminuria, and sleep apnea [Ref].

In addition, individuals who undergo a bariatric surgical procedure require fewer units of insulin and other medications to treat hypertension, dyslipidemia, and other comorbidities associated with obesity [Ref].

Bariatric Surgery’s Impact on Type 1 Diabetes:

The precise mechanisms for improved glycemic status following bariatric surgery in T1DM patients are unknown.

T1DM is characterized by autoimmune-cell destruction, which results in impaired insulin secretion. However, the rate of destruction can vary [Ref].

Bariatric surgery improves pancreatic islet size, function, and survival in T2D patients.

There is no evidence that patients with long-term T1DM with little or no residual-cell activity can regenerate an adequate level of insulin secretion after surgery.

As a result, the observed reduction in HbA1c in T1D cannot be as good as the reported outcomes of bariatric surgery in T2DM patients [Ref].

However, surgically induced weight loss lessens lipotoxicity in the liver and skeletal muscles as well as the pro-inflammatory environment linked to obesity, which can lessen the insulin resistance associated with obesity [Ref].

The incretin pathway, which inhibits glucagon release even in the absence of residual β-cells, may also play a role in better glucose metabolism in T1D patients after bariatric surgery [Ref].

According to research, T1D patients with residual β-cell function after 4 weeks of treatment with liraglutide had improved glucose control.

Some patients were able to stop taking insulin since the treatment’s impact was greater in those who still had measurable C-peptide from their residual β-cell [Ref]

One case series of T1DM showed that the amount of weight loss did not correspond with the reduction in basal insulin needs soon after gastric bypass, pointing to processes independent of weight loss [Ref].

The Benefits and Risks of Bariatric Surgery in Diabetic Patients:

• Risks of weight loss surgery:

Early and late postoperative problems can be classified as bariatric surgery hazards.

Bleeding, leak, infection, pulmonary embolism, and death are the early complications of bariatric surgery that occur most frequently.

Lack of vitamins and minerals, stenosis, anastomotic ulcer, and hernia are some of the late consequences.

Bariatric surgery mortality is influenced by a variety of variables, including the surgeon, facility, procedure, and patient-related factors.

Choosing the best surgical procedure for a given patient reduces the surgery’s risk and improves the outcome.

• Benefits of weight loss surgery:

Although there are some harmful effects of bariatric surgery, the advantages outweigh these risks.

Compared to the 4.5% risk of death from diabetic complications, the risk of dying through bariatric surgery is less than 0.3%.

In general, diabetic people are more likely to need bariatric surgery than non-diabetic ones.

Less than 1% of diabetics who undergo bariatric surgery die; this risk is justified by the significant benefits of decreased progression of type 2 diabetes in obese people.

Early bariatric surgery results in better outcomes. Numerous studies have demonstrated that the likelihood of remission increases with shorter diabetes duration.

Improperly treated diabetes causes the pancreatic beta cells to die, and losing weight enhances the beta cells’ sensitivity to glucose.

Early surgical intervention in diabetes patients maintains the pancreatic beta cells, leads to improved outcomes, and produces long-lasting remission.