Bariatric surgery is increasingly recognised as an effective treatment for obesity and related metabolic conditions. A recent study published in Diabetes Care has highlighted encouraging results for individuals living with type 1 diabetes (T1D) and obesity, suggesting that bariatric (weight loss) surgery may significantly improve metabolic health outcomes in this group.
Understanding the Link Between Obesity and Type 1 Diabetes
While type 1 diabetes is primarily an autoimmune condition characterised by insulin deficiency, many people with T1D also experience overweight or obesity, which can complicate diabetes management. Excess body weight may increase insulin requirements, worsen cardiovascular risk factors, and make blood glucose control more challenging.
As obesity rates continue to rise globally, clinicians are increasingly exploring whether metabolic bariatric surgery (MBS) could play a role in improving metabolic outcomes in people living with T1D.
Overview of the Study
The research, led by Rieneke van der Meer of the Nederlandse Obesitas Kliniek in the Netherlands and Sofia Pazmino of KU Leuven in Belgium, analysed data from 162 patients with type 1 diabetes and obesity who underwent bariatric surgery.
The study was a multicentre retrospective cohort analysis using electronic clinical records to evaluate outcomes up to 12 months after weight loss surgery. Participants had a median age of 37.5 years, and approximately 78% were women. Two common bariatric treatments were included:
- Sleeve gastrectomy (58%)
- Roux-en-Y gastric bypass (42%)
Researchers assessed multiple health outcomes, including body weight, BMI, insulin requirements, HbA1c levels, blood pressure, lipid profile, and kidney function.
Significant Weight Loss After Surgery
One of the most notable findings was the substantial weight loss achieved after surgery.
At 12 months:
- Median total weight loss reached nearly 30%
- Average BMI decreased from 40.2 to 28.5
This level of weight reduction represents a significant shift from the obesity category to a much healthier BMI range for many participants.
Reduced Insulin Requirements
Another key benefit observed was a major reduction in insulin needs.
Before surgery, patients required a median daily insulin dose of 82.6 units per day. After 12 months, this fell to 36.3 units per day, representing a dramatic decline in insulin requirements.
When adjusted for body weight, insulin use dropped from 0.75 units/kg/day to 0.32 units/kg/day. Researchers also found that greater weight loss was associated with lower insulin requirements, suggesting improved metabolic efficiency following surgery.
Improvements in Glycaemic Control and Cardiometabolic Health
In addition to weight loss and lower insulin use, the study reported improvements in several metabolic markers.
Median HbA1c levels decreased from 64 mmol/mol to 60 mmol/mol, indicating modest but meaningful improvements in long-term blood glucose control.
Other positive health changes included:
- Improved lipid profiles
- Reduced blood pressure
- Better overall cardiometabolic health indicators
Interestingly, the study found no significant difference in outcomes between sleeve gastrectomy and Roux-en-Y gastric bypass, suggesting that both procedures may offer similar metabolic benefits for patients with T1D and obesity.
Important Considerations
Despite the encouraging findings, the researchers emphasised that treatment decisions should always be individualised.
Metabolic bariatric surgery may provide the greatest benefits for individuals with higher BMI and increased cardiometabolic risk, but surgical risks, patient preferences, and overall health must be carefully considered.
The study also had some limitations. Because it was retrospective, it may be subject to bias. Additionally, there was no non-surgical comparison group, and longer-term outcomes were not consistently recorded. Further research will help clarify the long-term impact of bariatric surgery in people with type 1 diabetes.
Role for Bariatric Surgery in Metabolic Health
As evidence continues to emerge, metabolic bariatric surgery is gaining recognition not only as a weight-loss intervention but also as a powerful tool for improving metabolic health.
For individuals living with obesity and complex metabolic conditions, bariatric surgery may offer meaningful improvements in weight management, insulin requirements, and cardiovascular risk factors
At Phoenix Health, our bariatric team is committed to supporting patients with personalised, evidence-based bariatric treatment and helping them achieve sustainable improvements in health and quality of life.
References
https://diabetesjournals.org/care/article/doi/10.2337/dc25-2295/164502/Impact-of-Metabolic-Bariatric-Surgery-on-Weight
Medically Reviewed by Lujain Alhassan, BSc, ANutr
Registered Associate Nutritionist and Bariatric Nutrition
