Metabolic and Cardiometabolic Changes After Sleeve Gastrectomy in a Patient With Type 1 Diabetes and Morbid Obesity: A CARE-Compliant Case Report
DOI:
https://doi.org/10.5281/zenodo.19130904Keywords:
Type 1 diabetes mellitus, bariatric surgery, sleeve gastrectomy, obesity, insulin resistance, cardiometabolic risk, metabolic surgery, case reportAbstract
Background:
The prevalence of overweight and obesity in individuals with type 1 diabetes mellitus (T1DM) is increasing, contributing to insulin resistance, higher insulin requirements, and elevated cardiovascular risk. While bariatric surgery is an established treatment for severe obesity and type 2 diabetes, its role in T1DM remains less clearly defined, with limited and heterogeneous evidence from small studies and case series.
Case Presentation:
We report the case of a 33-year-old woman with a 19-year history of T1DM and morbid obesity (body mass index [BMI] 40.8 kg/m²) who underwent laparoscopic sleeve gastrectomy following multidisciplinary evaluation. Preoperatively, glycemic control was suboptimal (HbA1c 7.4%) and insulin requirements were high, particularly for prandial dosing. The patient also had hypertension, dyslipidemia, and active smoking history.
Results:
At 6 months postoperatively, the patient experienced substantial weight loss (BMI reduced to 27.2 kg/m²) and improved glycemic control (HbA1c 5.8%). Total daily insulin requirements decreased markedly, driven predominantly by a reduction in prandial insulin, while basal insulin requirements remained relatively stable. Improvements were also observed in blood pressure and lipid profile. In parallel, the patient discontinued smoking and increased physical activity. No episodes of diabetic ketoacidosis or severe hypoglycemia were reported during follow-up.
Conclusion:
In this single CARE-compliant case, sleeve gastrectomy was associated with significant short-term improvements in weight, glycemic control, insulin requirements, and cardiometabolic risk markers in a patient with T1DM and severe obesity. However, causal interpretation is limited by the single-patient design, short follow-up duration, and concurrent lifestyle modifications. Larger prospective studies are needed to clarify the role of metabolic surgery in carefully selected patients with T1DM.
Keywords: Type 1 diabetes mellitus; bariatric surgery; sleeve gastrectomy; obesity; insulin resistance; cardiometabolic risk; glycemic control; insulin requirements; metabolic surgery; case report; double diabetes; weight loss
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