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Chronic disease such as Diabetes Mellitus, Hypertension and cholesterol and Bariatric Surgery in Abu Dhabi - I have a lot of Data but trying to understand the status, prevalence and is the outcomes have been improved? And What can be done to make it better

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Obes Surg. 2016 Aug;26(8):1697-704. doi: 10.1007/s11695-015-1999-6.

Type 1 Diabetes Mellitus and Bariatric Surgery: A Systematic Review and Meta-Analysis.

Ashrafian H1,2,3, Harling L4, Toma T4, Athanasiou C4, Nikiteas N5, Efthimiou E4,6, Darzi A4, Athanasiou T4.

Author information

1

Department of Surgery and Cancer, Imperial College London, 10th Floor, Queen Elizabeth the Queen Mother (QEQM) Building, Imperial College Healthcare NHS Trust at St Mary's Hospital, Praed Street, London, W2 1NY, UK. [url removed, login to view]@imperial.ac.uk.

2

Department of Bariatric Surgery, Chelsea and Westminster Hospital, London, UK. [url removed, login to view]@imperial.ac.uk.

3

Department of Hepato-pancreato-biliary (HPB) Surgery, Hammersmith Hospital, London, UK. [url removed, login to view]@imperial.ac.uk.

4

Department of Surgery and Cancer, Imperial College London, 10th Floor, Queen Elizabeth the Queen Mother (QEQM) Building, Imperial College Healthcare NHS Trust at St Mary's Hospital, Praed Street, London, W2 1NY, UK.

5

Department of Surgery, Athens University Medical School, Athens, Greece.

6

Department of Bariatric Surgery, Chelsea and Westminster Hospital, London, UK.

Abstract

BACKGROUND:

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.

METHODS:

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.

RESULTS:

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.

CONCLUSIONS:

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.

KEYWORDS:

Bariatric surgery; Body mass index; Diabetes; Glycosylated haemoglobin; HbA1c; Intervention; Metabolic surgery; Surgery; Type 1 diabetes mellitus; Type 2 diabetes mellitus; Weight loss

PMID: 26694210 PMCID: PMC4951506 DOI: 10.1007/s11695-015-1999-6

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