Tip 1 Diabetes Mellituslu Obez Hastalarda Bariyatrik Cerrahinin Yeri

ÖzTip 1 DM hastalarında obezite ve metabolik sendrom sıklığı artmaktadır. Son verilere göre tip 1 DM’lu hastaların yaklaşık %50’si fazla kilolu ya da obezdir.Yine bu hastalarda metabolik sendrom sıklığı %40 oranında görülmektedir. Bu hastalarda bariyatrik cerrahi ile ilgili veriler sınırlı olmakla beraber çalışmalarda bariyatrik cerrahinin etkili kilo kontrolü sağlanabileceği, insülin ihtiyacında azalma olduğu, bazı hastalarda orta düzeyde HgA1c iyileşmesi sağlanabildiği ve komorbid hastalıklar üzerine olumlu etkileri olduğu bildirilmiştir. Operasyon sonrası bu hasta grubuna özel olarak sıklığı artmış hipoglisemi ve DKA gibi komplikasyonlar görülebileceği unutulmamalıdır. Olası endikasyonlar ve kontrendikasyonların belirlenmesi için bu alanda yapılacak ek çalışmalara ihtiyaç vardır.

Anahtar Kelimeler:

Bariatrik cerrahi, Tip 1 diyabetes mellitus

Bariatric Surgery in Obese Patients With Type 1 Diabetes Mellitus

AbstractThe incidence of obesity and metabolic syndrome is increasing in type 1 diabetes mellitus (DM) patients. Up to 50% of patients with type 1 DM are over-weight or obese. Similarly, the incidence of metabolic syndrome has been reported to be 40% in patients with type 1 DM. Bariatric surgery can provide effective weight control, reduce insulin doses, ameliorate modestly HgA1c in at leastsome of the patients, and have positive effects on comorbid diseases associatedwith obesity. It is worth to note here that some complications such as hypoglycemia and DKA may be seen more frequently in patients with type 1 DM afterbariatric surgery. Further studies with long-term follow-up data are needed to better understand the possible indications and contraindications of bariatric surgeryin this group of patients.

Keywords:

Bariatric surgery, type 1 diabetes mellitus,

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Kaynaklar 1.Kirwan JP, Aminian A, Kashyap SR, Burguera B, Bret-hauer SA, Schauer PR. Bariatric Surgery in Obese Pa-tients With Type 1 Diabetes. Diabetes care.2016;39(6):941-8. Epub 2016/05/26. doi: 10.2337/dc15-273 2. PubMed PMID: 27222552.2.Polsky S, Ellis SL. Obesity, insulin resistance, and type1 diabetes mellitus. Current opinion in endocrinology,diabetes, and obesity. 2015;22(4):277-82. Epub2015/06/19. doi: 10.1097/med. 0000000000000170.PubMed PMID: 26087341. 3.Mottalib A, Kasetty M, Mar JY, Elseaidy T, Ashrafza-deh S, Hamdy O. Weight Management in Patients withType 1 Diabetes and Obesity. Current diabetes reports.2017;17(10):92. Epub 2017/08/25. doi: 10.1007/s11892-017-0918-8. PubMed PMID: 28836234; PubMed Cen-tral PMCID: PMCPMC5569154. 4.Rizvi AA. The evolving role of bariatric surgery in pati-ents with type 1 diabetes and obesity. Integrative obesityand diabetes. 2016;2(2):195-9. Epub 2016/07/12. doi:10.15761/iod.1000144. PubMed PMID: 27398228; Pub-Med Central PMCID: PMCPMC4936488. 5.Chillaron JJ, Benaiges D, Mane L, Pedro-Botet J, Flo-res Le-Roux JA. Obesity and type 1 diabetes mellitus ma-nagement. Minerva endocrinologica. 2015;40(1):53-60.Epub 2014/11/22. PubMed PMID: 25413942. 6.American Diabetes A. Standards of Medical Care in Dia-betes—2015 Abridged for Primary Care Providers. Cli-nical Diabetes : A Publication of the American Diabe-tes Association. 2015;33(2):97-111. doi: 10.2337/diac-lin.33.2.9 7. PubMed PMID: PMC4398006.7.Vilarrasa N, Rubio MA, Minambres I, Flores L, CaixasA, Ciudin A, et al. Long-Term Outcomes in Patients withMorbid Obesity and Type 1 Diabetes Undergoing Ba-riatric Surgery. Obesity surgery. 2017;27(4):856-63.Epub 2016/10/07. doi: 10.1007/s11695-016-2390-y.PubMed PMID: 27709487.