{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T09:50:41Z","timestamp":1791366641734,"version":"4.3.1"},"reference-count":50,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2026,3,28]],"date-time":"2026-03-28T00:00:00Z","timestamp":1774656000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,3,28]],"date-time":"2026-03-28T00:00:00Z","timestamp":1774656000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Diabet Med"],"published-print":{"date-parts":[[2026,10]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>This systematic review evaluated the impact of metabolic and bariatric surgery (MBS) on weight loss, glycaemic control, insulin requirements and postoperative complications.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A PRISMA\u2010compliant, PROSPERO\u2010registered systematic review and meta\u2010analysis (CRD42025123500) was conducted. Medline, PubMed, Embase, Scopus and CENTRAL were searched. Primary outcomes were changes in body weight, BMI, HbA1c and insulin requirements following MBS. Risk of bias was assessed using ROBINS\u2010I and RoB\u20102, and certainty of evidence using GRADE.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Twenty\u2010two studies, including 1324 adults with type 1 diabetes mellitus (mean age 42.2\u2009\u00b1\u200911.6\u2009years; mean follow\u2010up 31.6\u2009\u00b1\u200918.2\u2009months), were analysed. Of 753 participants with reported sex, 74.6% were women (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u2009562). A total of 1304 procedures were performed, most commonly Roux\u2010en\u2010Y gastric bypass (44.5%;\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u2009580) and sleeve gastrectomy (39.2%;\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u2009512), followed by adjustable gastric banding (13.0%;\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u2009170). Meta\u2010analysis demonstrated significant reductions in body weight (mean difference 29.55\u2009kg; 95% CI 25.72 to 33.39;\n                      <jats:italic>I<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      \u2009=\u200920%) and BMI (11.35\u2009kg\/m\n                      <jats:sup>2<\/jats:sup>\n                      ; 95% CI 10.36 to 12.34;\n                      <jats:italic>I<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      \u2009=\u200932%). HbA1c decreased by 4\u2009mmol\/mol (95% CI 2.05 to 6.78;\n                      <jats:italic>I<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      \u2009=\u200919%), and insulin requirements declined by 43%\u201348% (0.20\u2009U\/kg; 95% CI 0.13 to 0.26;\n                      <jats:italic>I<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      \u2009=\u200958%). Postoperative complications included diabetic ketoacidosis (15\/182, 8%) and severe hypoglycaemia (21\/516, 4%); any complication occurred in 21\/495 (4%). Evidence quality was low.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>MBS achieves weight loss and reduces insulin requirements in adults with type 1 diabetes mellitus and obesity, but glycaemic improvements are minimal. Given the observational evidence base and inconsistent safety reporting, true metabolic risk remains uncertain. High\u2010quality prospective studies with standardised outcome definitions are needed.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/dme.70305","type":"journal-article","created":{"date-parts":[[2026,3,29]],"date-time":"2026-03-29T03:05:07Z","timestamp":1774753507000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Metabolic and bariatric surgery for patients with obesity type 1 diabetes mellitus: A comprehensive updated systematic review and meta\u2010analysis"],"prefix":"10.1111","volume":"43","author":[{"ORCID":"https:\/\/orcid.org\/0009-0006-6357-0053","authenticated-orcid":false,"given":"Sebastian","family":"Mitchell","sequence":"first","affiliation":[{"name":"Clinical Department of Surgery University of Edinburgh, Royal Infirmary of Edinburgh  Edinburgh UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ketaki","family":"Patwardhan","sequence":"additional","affiliation":[{"name":"Clinical Department of Surgery University of Edinburgh, Royal Infirmary of Edinburgh  Edinburgh UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James","family":"Lucocq","sequence":"additional","affiliation":[{"name":"Clinical Department of Surgery University of Edinburgh, Royal Infirmary of Edinburgh  Edinburgh UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Georgios","family":"Geropoulos","sequence":"additional","affiliation":[{"name":"Clinical Department of Surgery University of Edinburgh, Royal Infirmary of Edinburgh  Edinburgh UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter J.","family":"Lamb","sequence":"additional","affiliation":[{"name":"Clinical Department of Surgery University of Edinburgh, Royal Infirmary of Edinburgh  Edinburgh UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Omar","family":"Ghanem","sequence":"additional","affiliation":[{"name":"Department of Surgery, Endocrine and Metabolic Surgery Mayo Clinic  Rochester Minnesota USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roland H.","family":"Stimson","sequence":"additional","affiliation":[{"name":"Edinburgh Centre for Endocrinology &amp; 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