Bariatric Surgery in Patients With Obesity and Latent Autoimmune Diabetes in Adults (LADA).

Abstract

Bariatric surgery induces weight loss and restores glucose metabolism in patients with obesity and type 2 diabetes (T2D) (1). In patients with autoimmune diabetes that eventually results in β-cell failure, the glycemic effects of bariatric surgery are limited (2). Adult patients with latent autoimmune diabetes in adults (LADA) have a slower decline in β-cell function and lower requirement for insulin therapy than patients with classical young-onset type 1 diabetes (T1D) (3). They are often misdiagnosed as having T2D and might have unrealistic expectations of diabetes remission after bariatric surgery with additional risk for development of postoperative diabetic ketoacidosis (DKA) (4). The safety and efficacy of bariatric surgery in patients with obesity and LADA have not been characterized. We retrospectively analyzed medical records of patients with obesity and LADA who underwent bariatric surgery at the Cleveland Clinic Health System in the U.S. LADA status was defined as adult-onset diabetes with presence of GAD antibodies. We compared pre- and postsurgery BMI, glycemic control (HbA1c), daily insulin dose, and blood pressure and lipid profile using a paired Student t test, with a P value of 0.05 considered significant. Between October 2006 and March 2018, nine female patients underwent laparoscopic bariatric surgery (five Roux-en-Y gastric bypass and four sleeve gastrectomy) and one male patient underwent sleeve gastrectomy. The median age at …