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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\u2013ileal bypass with sleeve gastrectomy (SADI-S) in adults with T1DM.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Materials and methods<\/jats:title>\n                    <jats: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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Eight patients contributed five-year outcome data. Mean BMI decreased from 38.6\u00a0kg\/m\u00b2 to 26.4\u00a0kg\/m\u00b2. 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats: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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s12020-026-04664-x","type":"journal-article","created":{"date-parts":[[2026,6,1]],"date-time":"2026-06-01T12:13:10Z","timestamp":1780315990000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Five-year outcomes of single-anastomosis duodeno\u2013ileal bypass with sleeve gastrectomy (SADI-S) in adults with type 1 diabetes mellitus"],"prefix":"10.1007","volume":"91","author":[{"given":"Ravi S.","family":"Rao","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gabrielle","family":"Hogan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aditya","family":"Rao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ashlen","family":"Sweeny","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Munish","family":"Mehta","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,6,1]]},"reference":[{"key":"4664_CR1","doi-asserted-by":"publisher","first-page":"69","DOI":"10.1016\/S0140-6736(13)60591-7","volume":"383","author":"MA Atkinson","year":"2014","unstructured":"M.A. Atkinson, G.S. 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