Obesity and Insulin Resistance in Type 1 Diabetes Mellitus: From Bariatric Surgery to Pancreas Transplantation

Background: Obese patients with type 1 diabetes mellitus can develop insulin resistance.While medical therapy to treat insulin resistance in patients with type 1 diabetes mellitus is often limited, bariatric surgery has been used to promote weight loss and to improve insulin sensitivity.However, postoperative bariatric surgery outcomes reported for some patients with type 1 diabetes mellitus have included insufficient glycemic control and hypoglycemia.Case Report: A female patient who had been diagnosed with type 1 diabetes mellitus at age 20 years developed morbid obesity and medically refractory insulin resistance over a 20-year period.She underwent bariatric surgery at age 42 years, achieving substantial weight loss (body mass index of 21 kg/m 2 ) and improved insulin resistance.Despite this improvement, the patient continued to experience poor glycemic control and began to have recurrent episodes of hypoglycemia despite receiving maximal medical therapy.At age 49 years, she underwent pancreas transplantation that restored glucose regulation.Conclusion: In select obese patients with type 1 diabetes mellitus, insulin resistance, and poor glycemic control, bariatric surgery followed by pancreas transplantation may offer a viable pathway to reduce weight, improve insulin sensitivity, and restore glucose homeostasis.