Bariatric surgery holds potential CV benefits, hyperglycemia risks for adults with type 1 diabetes
Adults with obesity and type 1 diabetes may be at lower risk for cardiovascular death, heart failure, stroke and cardiovascular disease after bariatric surgery, although hyperglycemia and hypoglycemia risks may rise as well, according to findings presented at the European Association for the Study of Diabetes annual meeting.
“Our primary message was that there are benefits of gastric bypass surgery for the type 1 population, but at the same time there are very big risks as well. We need to decide if the patient should undergo surgery on an individual basis, but right now, we think the risk overweighs the benefits generally,” Gudrún Höskuldsdóttir, MD, a specialist of internal medicine at the Diabetes Center at Sahlgrenska University Hospital and a PhD student at the University of Gothenburg in Sweden, told Endocrine Today. “It’s important because our patients are asking for bariatric surgery, the type 1 population is.”
Höskuldsdóttir and colleagues conducted a retrospective, register-based nationwide cohort study in which they identified 387 adults (mean age, 41.65 years; 77% women; mean BMI, 40.77 kg/m2) with type 1 diabetes in the Swedish National Diabetes Register and Scandinavian Obesity Surgery Registry who had Roux-en-Y gastric bypass surgery. The researchers then matched these individuals with 387 adults (mean age, 41.15 years; 89.1% women; mean BMI, 39.39 kg/m2) with type 1 diabetes who did not have surgery.
Instances of all-cause mortality, CV mortality, CVD, hypoglycemia and hyperglycemia between 2007 and 2013 were identified based on hospital discharge and cause of death information in the registries. Mean follow-up was 5.8 years for all-cause mortality and 4.7 years for all other outcomes.
Compared with the non-surgery group, the bariatric surgery group had an 85% lower risk for CV death (HR = 0.15; 95% CI, 0.03-0.68), a 68% lower heart failure risk (HR = 0.32; 95% CI, 0.15-0.67), an 82% lower stroke risk (HR = 0.18; 95% CI, 0.04-0.82) and a 57% lower CVD risk (HR = 0.43; 95% CI, 0.2-0.9). However, Höskuldsdóttir noted that differences in all-cause mortality, myocardial infarction and atrial fibrillation were not statistically significant.
The researchers also observed a nearly twofold increase in hyperglycemia risk (HR = 1.99; 95% CI, 1.07-3.72) and a “numerical but not significant increase in serious hyperglycemia events” among the surgery group, although Höskuldsdóttir noted that these data only reflected hyperglycemic and hypoglycemic events that required hospitalization.
“It’s important when you discuss a surgery that it’s a discussion between the diabetes team, the patient and the surgeon and that the patient is well-informed of the risks and the benefits of surgery,” Höskuldsdóttir said. “Now we know that there are benefits, but we’ve also shown that there are risks that the patients need to be aware of.”
Höskuldsdóttir also noted that additional factors must be considered when evaluating bariatric surgery among adults with type 1 diabetes in future research.
“It’s important that we look closely at the technology that the patients are using — how many patients are using pumps and how many patients are using CGM — and we need to look more closely at malnutrition and other postoperative complications,” Höskuldsdóttir said. “We also need to see how the patients do with regard to sustained weight loss — if they can keep the weight off in a more long-term period — because the anabolic effects of insulin can make the weight loss difficult.” – by Phil Neuffer
Höskuldsdóttir G, et al. OP 16. Presented at: European Association for the Study of Diabetes Annual Meeting; Sept. 16-20, 2019; Barcelona, Spain.
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Gudrún Höskuldsdóttir can be reached at firstname.lastname@example.org.
Disclosure: Höskuldsdóttir reports no relevant financial disclosures.