>> Thursday, April 28, 2016
In parallel with the obesity epidemic in our general society, so too do many type 1 diabetics struggle with excess weight. I am often asked whether patients with type 1 diabetes could benefit from bariatric surgery.
First, a review on the difference between Type 1 vs Type 2 diabetes:
- Type 1 diabetes is an autoimmune condition, where the immune system mounts a response against the pancreas, causing the pancreas to stop producing insulin. Type 1 diabetics require insulin as treatment.
- Type 2 diabetes is a condition where the body is resistant to the effects of insulin. This means that the pancreas has to work harder to make enough insulin to put sugar into cells for use as energy. Over time, the overworked pancreas gets tired, its ability to produce enough insulin to control blood sugars declines, and diabetes develops. Some Type 2 diabetics are treated with lifestyle modification alone, some with pills or injectable medication, and some require insulin because their pancreas is too tired to make the insulin they need.
There is lots of evidence to support the efficacy of bariatric surgery (especially gastric bypass surgery and sleeve gastrectomy) to improve control of type 2 diabetes, or even send it into remission (meaning the type 2 diabetes goes away - though it may reoccur later).
For type 1 diabetes, there is very little data. However, a recent review summarizes the literature available for us, and what it found is that while bariatric surgery can be of benefit to help people with type 1 diabetes lose weight and reduce risk factors for heart disease, diabetes control does not seem to improve overall.
So, while bariatric surgery can be an appropriate treatment strategy for type 2 diabetes in people who struggle with obesity, the evidence does not support it for the improvement of diabetes control in type 1 diabetes.
Follow me on twitter! @drsuepedersen