Metabolic and Cardiometabolic Changes After Sleeve Gastrectomy in a Patient With Type 1 Diabetes and Morbid Obesity: A CARE-Compliant Case Report

This CARE-compliant case report presents a detailed clinical evaluation of metabolic and cardiometabolic outcomes following laparoscopic sleeve gastrectomy in a patient with long-standing type 1 diabetes mellitus (T1DM) and morbid obesity. The report describes the case of a 33-year-old woman with a 19-year history of T1DM, significant insulin resistance, and multiple cardiometabolic risk factors, including hypertension, dyslipidemia, and active smoking. Prior to surgery, glycemic control was suboptimal and insulin requirements were elevated. At 6-month follow-up, substantial improvements were observed, including marked weight loss (BMI reduction from 40.8 to 27.2 kg/m²), improved glycemic control (HbA1c reduction from 7.4% to 5.8%), and a significant decrease in total daily insulin requirements—primarily driven by reduced prandial insulin needs. Additional benefits included improvements in blood pressure and lipid profile, as well as positive lifestyle changes such as smoking cessation and increased physical activity. Importantly, no major adverse events were reported during the follow-up period, including diabetic ketoacidosis or severe hypoglycemia. While bariatric surgery is well established in type 2 diabetes, its role in T1DM remains less clearly defined. This case contributes to the growing body of evidence suggesting that metabolic surgery may offer meaningful benefits in carefully selected patients with T1DM and severe obesity. However, interpretation is limited by the single-patient design, short follow-up duration, and concurrent lifestyle modifications. The findings highlight the potential of sleeve gastrectomy as an adjunctive therapeutic strategy in T1DM, while underscoring the need for larger prospective studies to clarify long-term efficacy, safety, and patient selection criteria.