Metabolic surgery (gastric bypass) has no magical effect' in severely obese patients with type 1 diabetes
Gideon Mlawa1,2, Sandeep Deshmukh1, Cecil Eboh2, Asrai Nasruddin1 & Patrick Sharp1
Background: Metabolic surgery has been hailed as a potential new treatment (magic bullet) for obese patients with type2 diabetes. Several studies have shown that metabolic surgery for morbid obese patients with type2 diabetes can lead to considerable weight loss and also has positive impact on the incidence of type2 diabetes, in some cases leading to elimination of the disease in up to 80% of patients. But metabolic surgery do not seem to induce similar magic effect and control of glycaemia in patients with type1 diabetes.
Methods: We present a case report of 44 years old man type1 diabetes with severe obesity for many years and poor glycaemia control (HbA1c 11.2%) He was normotensive, and his cholesterol level was 6.8, and he was on simvastatin, he had no diabetic retinopathy. He was on basal bolus regime and his daily insulin requirement was 160 units, his weight was 163.83 kg, BMI 48 kg/m2 underwent Roux-en-Y gastric bypass in July 2008.
Results: he postoperative period was uneventful, 1 year after surgery his body weight was 108.6 kg, (25% reduction), cholesterol 4.7 his daily insulin dose reduced to 77 units. However his glycaemic control remained erratic and poor (HbA1c 10.2%). He was found to have proliferative diabetic retinopathy on the right eye, and macula involvement in the left, and needed laser treatment to the right eye. He is still being followed up, in diabetic clinic every 3 months.
Conclusion: Metabolic surgery leads to significant and maintained weight loss, and good control in lipid profile in type1 diabetes patients with severe obesity, but has less impact on glycaemic control itself as demonstrate in this case report. Severely obese patients with type1 diabetes have to be informed that metabolic surgery will not lead to the cure of diabetes but will improve other co-morbidities such as hyperlipidaemia, hypertension and obstructive sleep apnoea syndrome.