Lights and Shadows of Bariatric Surgery: Insights from a Nationwide Administrative Database of People Living with Type 1 Diabetes and Obesity.

Abstract

Introduction: The study aimed to describe the population of patients living with type 1 diabetes who had access to bariatric surgery (BS) in France, analyzing the changes in healthcare resource use and associated costs in the 3 years following this surgery.

Methods: An observational longitudinal study based on the French national health insurance database was conducted on all adult patients that underwent a first BS from 2015 to 2020. Cost analyses were conducted on a sub-population who underwent BS from 2016 to 2017 for sufficient observation time using a pre-post methodology.

Results: A total of 437 patients were identified as living with type 1 diabetes among the 234,077 patients who had undergone surgery over 6 years (2015-2020). The most frequently performed interventions were sleeve gastrectomy (n = 272; 62.2%) and gastric bypass (n = 154; 35.2%), with the majority of patients being women (77.8%) and an average age of 42.3 (± 12.0) years, consistent with the general population undergoing BS in France. While no significant differences were found in the overall healthcare costs when comparing the 3 years before and after BS, there was an increase in the frequency of biological measurements. Expenditures related to antidiabetic medications and insulin decreased significantly (p < 0.0001). The number of hospitalizations for severe hypoglycemia, coma, and ketoacidosis more than doubled in the 3 years following surgery compared with the period before (p = 0.04).

Conclusions: The risks of severe hypoglycemia or ketoacidosis in patients with type 1 diabetes undergoing BS remains a real concern and emphasizes the importance of involving the diabetologist in the operative decision with joint follow-up with the nutritionist.