Impact of Metabolic Bariatric Surgery on Weight Loss and Glycemic Control in Adults With Type 1 Diabetes: A Multicenter Retrospective Cohort Study.

Abstract

To assess the effect of metabolic bariatric surgery (MBS) in people living with type 1 diabetes (T1D) and obesity. From retrospective multicenter data, total weight loss, daily insulin requirement, HbA1c, and cardiometabolic parameters were assessed before and after surgery. Longitudinal models were used to identify response determinants. This study included 162 people living with T1D and obesity. One year after surgery, mean total weight loss percentage was 29.7% (interquartile range [IQR] = 29.4, 30.3). Insulin requirements dropped from 0.75 (IQR = 0.58, 1.00) units/kg/day to 0.32 (IQR = 0.23, 0.43) units/kg/day (P < 0.001), and HbA1c dropped from 64.0 (IQR = 57.0, 74.0) mmol/mol to 60.0 (IQR = 53.4, 68.0) mmol/mol (P < 0.001). LDL, HDL, total cholesterol, and triglyceride levels significantly improved after surgery (P < 0.001). Greater total weight loss was associated with reduced insulin requirements, and higher baseline HbA1c was associated with poorer postsurgery glycemic control. MBS was associated with substantial metabolic improvement in people with T1D and obesity, in particular in those with high HbA1c and insulin need at baseline.