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Background <p>Managing obesity in adults with type 1 diabetes mellitus (T1DM) is challenging because insulin dependence often coexists with significant insulin resistance. While metabolic surgery is well established in type 2 diabetes, long-term data in T1DM remain limited. This study evaluates five-year outcomes of single-anastomosis duodeno–ileal bypass with sleeve gastrectomy (SADI-S) in adults with T1DM.</p> Materials and methods <p>Adults with T1DM and obesity who underwent primary SADI-S at a single center were followed for up to five years. Outcomes included weight, BMI, HbA1c, total daily insulin requirements, continuous glucose monitoring (CGM) metrics, nutritional status, peri-operative safety, and patient-reported quality-of-life measures. CGM data were analyzed for time in range, glycemic variability, time above range, and time below range. Patient-reported outcomes included the SF-12, Diabetes Treatment Satisfaction Questionnaire, and BAROS.</p> Results <p>Eight patients contributed five-year outcome data. Mean BMI decreased from 38.6&#xa0;kg/m² to 26.4&#xa0;kg/m². HbA1c improved from 8.4% to 7.1%, and total daily insulin requirements decreased by approximately 45%. CGM data demonstrated increased time in range, reduced glycemic variability, and stable rates of hypoglycemia. Quality-of-life scores improved across all validated domains. Two cases of early postoperative euglycemic diabetic ketoacidosis occurred before implementation of extended inpatient monitoring; none occurred thereafter. No patient developed protein-calorie malnutrition or severe micronutrient deficiency.</p> Conclusions <p>SADI-S produced sustained weight loss, improved glycemic stability, reduced insulin requirements, and acceptable nutritional outcomes over five years in adults with T1DM. These findings support SADI-S as a physiologically favorable metabolic procedure in carefully selected insulin-treated individuals.</p>

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Five-year outcomes of single-anastomosis duodeno–ileal bypass with sleeve gastrectomy (SADI-S) in adults with type 1 diabetes mellitus

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年6月1日

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  • Ravi S. Rao,
  • Gabrielle Hogan,
  • Aditya Rao,
  • Ashlen Sweeny,
  • Munish Mehta

摘要

Background

Managing obesity in adults with type 1 diabetes mellitus (T1DM) is challenging because insulin dependence often coexists with significant insulin resistance. While metabolic surgery is well established in type 2 diabetes, long-term data in T1DM remain limited. This study evaluates five-year outcomes of single-anastomosis duodeno–ileal bypass with sleeve gastrectomy (SADI-S) in adults with T1DM.

Materials and methods

Adults with T1DM and obesity who underwent primary SADI-S at a single center were followed for up to five years. Outcomes included weight, BMI, HbA1c, total daily insulin requirements, continuous glucose monitoring (CGM) metrics, nutritional status, peri-operative safety, and patient-reported quality-of-life measures. CGM data were analyzed for time in range, glycemic variability, time above range, and time below range. Patient-reported outcomes included the SF-12, Diabetes Treatment Satisfaction Questionnaire, and BAROS.

Results

Eight patients contributed five-year outcome data. Mean BMI decreased from 38.6 kg/m² to 26.4 kg/m². HbA1c improved from 8.4% to 7.1%, and total daily insulin requirements decreased by approximately 45%. CGM data demonstrated increased time in range, reduced glycemic variability, and stable rates of hypoglycemia. Quality-of-life scores improved across all validated domains. Two cases of early postoperative euglycemic diabetic ketoacidosis occurred before implementation of extended inpatient monitoring; none occurred thereafter. No patient developed protein-calorie malnutrition or severe micronutrient deficiency.

Conclusions

SADI-S produced sustained weight loss, improved glycemic stability, reduced insulin requirements, and acceptable nutritional outcomes over five years in adults with T1DM. These findings support SADI-S as a physiologically favorable metabolic procedure in carefully selected insulin-treated individuals.