Current status and perspective of bariatric surgery in the treatment of type 1 diabetes with obesity

Abstract

With the development of social economy and the change of lifestyle and working environment, the number of obese and diabetic population has increased significantly. Obesity is closely related to diabetes mellitus with interaction. Among the patients with type 1 diabetes mellitus (T1DM), the cardiovascular risk of T1DM with obesity is significantly higher than those of lean T1DM. The mortality of T1DM with obesity is significantly higher than that of the general population, which poses a great threat to human health, making it become one of the serious public health problems we have to face at present. However, the traditional treatment method of obesity and diabetes has limited effects and fails to effectively solve obesity, diabetes mellitus and its complications. The birth of bariatric surgery brings a new hope to the treatment of obesity and diabetes. After more than half of a century progress, bariatric surgery has become an effective way to cure or relieve obesity, type 2 diabetes and other metabolic syndromes, which is included in the diabetes treatment guidelines. In patients with diabetes, there are a large number of T1DM patients with obesity being in urgent need of surgical treatment, but only a few patients were reported. From the existing papers and case reports , we can see parameters in many aspects, such as BMI, insulin requirement per day, blood pressure and blood plasma lipid, were significantly reduced after bariatric surgery as well as insulin resistance, diabetic complications, polycystic ovarian syndrome and obstructive sleep apnea hypopnea syndrome were improved or even reversed. However, bariatric surgery in treating T1DM with obesity has not yet reached a consensus in the medical community and not been written to diabetes treatment guidelines. In this paper, the operation methods and mechanism, curative effects, disadvantages and its preventive measures, current status and perspective of bariatric surgery in treating T1DM with obesity are reviewed so as to provide reference for clinical practice.