Bariatric surgery in the treatment of patients with obesity and type 1 diabetes: A retrospective study of clinical data

There are not many real-world studies evaluating daily insulin doses requirements (DIDR) in patients with type 1 diabetes (T1D) using second-generation basal insulin analogs, and such comparison is necessary. The aim of this study was to compare DIDR in individuals with T1D using glargine 300 UI/mL (IGlar-300) or degludec (IDeg) in real clinical practice. An observational, retrospective study was designed in 412 patients with T1D (males: 52%; median age 37.0±13.4 years, diabetes duration: 18.7±12.3 years) using IDeg and IGla-300 ≥6 months to compare DIDR between groups. Patients using IGla-300 (n=187) were more frequently males (59% vs 45.8%; p=0.004) and had lower glycosylated hemoglobin (HbA1c) (7.6±1.2 vs 8.1%±1.5%; p<0.001) than patients using IDeg (n=225). Total (0.77±0.36 unit/kg/day), basal (0.43±0.20 unit/kg/day) and prandial (0.33±0.23 unit/kg/day) DIDR were similar in IGla-300 and IDeg groups. Patients with HbA1c ≤7% (n=113) used significantly lower basal (p=0.045) and total (p=0.024) DIDR, but not prandial insulin (p=0.241), than patients with HbA1c between 7.1% and 8% and >8%. Patients using IGla-300 and IDeg used similar basal, prandial and total DIDR regardless of metabolic control subgroup. No difference in basal, prandial and total DIDR was observed between patients with T1D using IGla-300 or IDeg during at least 6 months in routine clinical practice.

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Cause or effect? A review of clinical data demonstrating beta cell dysfunction prior to the clinical onset of type 1 diabetes

Molecular Metabolism ◽

10.1016/j.molmet.2019.06.010 ◽

2019 ◽

Vol 27 ◽

pp. S129-S138 ◽

Cited By ~ 2

Author(s):

Emily K. Sims ◽

Linda A. DiMeglio

Keyword(s):

Type 1 Diabetes ◽

Beta Cell ◽

Clinical Data ◽

Beta Cell Dysfunction ◽

Cell Dysfunction ◽

Clinical Onset

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Bariatric Surgery and Type 1 Diabetes: Unanswered Questions

Frontiers in Endocrinology ◽

10.3389/fendo.2020.525909 ◽

2020 ◽

Vol 11 ◽

Author(s):

Emmanouil Korakas ◽

Aikaterini Kountouri ◽

Athanasios Raptis ◽

Alexander Kokkinos ◽

Vaia Lambadiari

Keyword(s):

Bariatric Surgery ◽

Type 1 Diabetes

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A Multiple Hypothesis Approach to Estimating Meal Times in Individuals With Type 1 Diabetes

Journal of Diabetes Science and Technology ◽

10.1177/1932296819883267 ◽

2019 ◽

Vol 15 (1) ◽

pp. 141-146

Author(s):

John P. Corbett ◽

Marc D. Breton ◽

Stephen D. Patek

Keyword(s):

Type 1 Diabetes ◽

Clinical Data ◽

Estimation Error ◽

Average Error ◽

Accurate Information ◽

Data Set ◽

Multiple Hypothesis ◽

Meal Time ◽

Normally Distributed

Introduction: It is important to have accurate information regarding when individuals with type 1 diabetes have eaten and taken insulin to reconcile those events with their blood glucose levels throughout the day. Insulin pumps and connected insulin pens provide records of when the user injected insulin and how many carbohydrates were recorded, but it is often unclear when meals occurred. This project demonstrates a method to estimate meal times using a multiple hypothesis approach. Methods: When an insulin dose is recorded, multiple hypotheses were generated describing variations of when the meal in question occurred. As postprandial glucose values informed the model, the posterior probability of the truth of each hypothesis was evaluated, and from these posterior probabilities, an expected meal time was found. This method was tested using simulation and a clinical data set ( n = 11) and with either uniform or normally distributed ( μ = 0, σ = 10 or 20 minutes) prior probabilities for the hypothesis set. Results: For the simulation data set, meals were estimated with an average error of −0.77 (±7.94) minutes when uniform priors were used and −0.99 (±8.55) and −0.88 (±7.84) for normally distributed priors ( σ = 10 and 20 minutes). For the clinical data set, the average estimation error was 0.02 (±30.87), 1.38 (±21.58), and 0.04 (±27.52) for the uniform priors and normal priors ( σ = 10 and 20 minutes). Conclusion: This technique could be used to help advise physicians about the meal time insulin dosing behaviors of their patients and potentially influence changes in their treatment strategy.

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Bariatric surgery in patients with type 1 diabetes: special considerations are warranted

Therapeutic Advances in Endocrinology and Metabolism ◽

10.1177/2042018818822207 ◽

2019 ◽

Vol 10 ◽

pp. 204201881882220 ◽

Cited By ~ 5

Author(s):

Zohar Landau ◽

Galit Kowen-Sandbank ◽

Daniela Jakubowicz ◽

Asnat Raziel ◽

Nasser Sakran ◽

...

Keyword(s):

Bariatric Surgery ◽

Type 1 Diabetes ◽

Diabetic Ketoacidosis ◽

Glucose Control ◽

Healthcare Services ◽

Short And Long Term ◽

The Mean

Objective: We examined short and long-term outcomes of bariatric surgery in patients with obesity and type 1 diabetes mellitus (T1DM). Methods: We reviewed the records of all adults insured by Maccabi Healthcare Services during 2010 -2015, with body mass index (BMI) ⩾30 kg/m2 and T1DM; and compared weight reduction and glucose control according to the performance of bariatric surgery. BMI and glycated hemoglobin (HbA1c) levels were extracted for baseline and every 6 months, for a mean 3.5 years. Results: Of 52 patients, 26(50%) underwent bariatric surgery. Those who underwent surgery were more often female and with a longer duration of diabetes. Immediately postoperative, 4(15%) developed diabetic ketoacidosis, while 6(23%) experienced severe hypoglycemic episodes. The mean BMI decreased among surgery patients: from 39.5±4.4 to 30.1±5.0 kg/m2 ( p < 0.0001); and increased among those who did not undergo surgery: from 33.6±3.9 to 35.1±4.4 kg/m2 ( p = 0.49). The mean HbA1c level decreased during the first 6 months postoperative: from 8.5±0.9% to 7.9±0.9%; however, at the end of follow-up, was similar to baseline, 8.6±2.0% (p = 0.87). For patients who did not undergo surgery, the mean HbA1c increased from 7.9±1.9% to 8.6±1.5% ( p = 0.09). Conclusions: Among individuals with obesity and T1DM, weight loss was successful after bariatric surgery, but glucose control did not improve. The postoperative risks of diabetic ketoacidosis and severe hypoglycemic episodes should be considering when performing bariatric surgery in this population.

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