scholarly journals Five-year kidney outcomes of bariatric surgery differ in severely obese adolescents and adults with and without type 2 diabetes

2020 ◽  
Vol 97 (5) ◽  
pp. 995-1005
Author(s):  
Petter Bjornstad ◽  
Edward Nehus ◽  
Todd Jenkins ◽  
Mark Mitsnefes ◽  
Marva Moxey-Mims ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Bariatric Surgery ◽  
Obese Adolescents ◽  
Adolescents And Adults ◽  
Severely Obese

scholarly journals Utilising a milk-based meal replacement programme in a bariatric patient with poorly controlled type 2 diabetes mellitus

2019 ◽  
Vol 2019 ◽  
Author(s):  
Michelle Maher ◽  
Mohammed Faraz Rafey ◽  
Helena Griffin ◽  
Katie Cunningham ◽  
Francis M Finucane
Keyword(s):  
Type 2 Diabetes ◽  
Bariatric Surgery ◽  
Weight Loss ◽  
Glycaemic Control ◽  
Severe Obesity ◽  
Meal Replacement ◽  
Agonist Therapy ◽  
Severely Obese ◽  
Skimmed Milk

Summary A 45-year-old man with poorly controlled type 2 diabetes (T2DM) (HbA1c 87 mmol/mol) despite 100 units of insulin per day and severe obesity (BMI 40.2 kg/m2) was referred for bariatric intervention. He declined bariatric surgery or GLP1 agonist therapy. Initially, his glycaemic control improved with dietary modification and better adherence to insulin therapy, but he gained weight. We started a low-energy liquid diet, with 2.2 L of semi-skimmed milk (equivalent to 1012 kcal) per day for 8 weeks (along with micronutrient, salt and fibre supplementation) followed by 16 weeks of phased reintroduction of a normal diet. His insulin was stopped within a week of starting this programme, and over 6 months, he lost 20.6 kg and his HbA1c normalised. However, 1 year later, despite further weight loss, his HbA1c deteriorated dramatically, requiring introduction of linagliptin and canagliflozin, with good response. Five years after initial presentation, his BMI remains elevated but improved at 35.5 kg/m2 and his glycaemic control is excellent with a HbA1c of 50 mmol/mol and he is off insulin therapy. Whether semi-skimmed milk is a safe, effective substrate for carefully selected patients with severe obesity complicated by T2DM remains to be determined. Such patients would need frequent monitoring by an experienced multidisciplinary team. Learning points: Meal replacement programmes are an emerging therapeutic strategy to allow severely obese type 2 diabetes patients to achieve clinically impactful weight loss. Using semi-skimmed milk as a meal replacement substrate might be less costly than commercially available programmes, but is likely to require intensive multidisciplinary bariatric clinical follow-up. For severely obese adults with poor diabetes control who decline bariatric surgery or GLP1 agonist therapy, a milk-based meal replacement programme may be an option. Milk-based meal replacement in patients with insulin requiring type 2 diabetes causes rapid and profound reductions in insulin requirements, so rigorous monitoring of glucose levels by patients and their clinicians is necessary. In carefully selected and adequately monitored patients, the response to oral antidiabetic medications may help to differentiate between absolute and relative insulin deficiency.

scholarly journals Bariatric surgery: an IDF statement for obese Type 2 diabetes

2011 ◽  
Vol 55 (6) ◽  
pp. 367-382 ◽  
Author(s):  
JB Dixon ◽  
P Zimmet ◽  
KG Alberti ◽  
F Rubino
Keyword(s):  
Type 2 Diabetes ◽  
Bariatric Surgery ◽  
International Diabetes Federation ◽  
Cost Effective ◽  
National Guidelines ◽  
Recommended Treatment ◽  
Treatment And Prevention ◽  
Surgical Access ◽  
Severely Obese

The International Diabetes Federation Taskforce on Epidemiology and Prevention of Diabetes convened a consensus working group of diabetologists, endocrinologists, surgeons and public health experts to review the appropriate role of surgery and other gastrointestinal interventions in the treatment and prevention of Type 2 diabetes. The specific goals were: to develop practical recommendations for clinicians on patient selection; to identify barriers to surgical access and suggest interventions for health policy changes that ensure equitable access to surgery when indicated; and to identify priorities for research. Bariatric surgery can significantly improve glycaemic control in severely obese patients with Type 2 diabetes. It is an effective, safe and cost-effective therapy for obese Type 2 diabetes. Surgery can be considered an appropriate treatment for people with Type 2 diabetes and obesity not achieving recommended treatment targets with medical therapies, especially in the presence of other major co-morbidities. The procedures must be performed within accepted guidelines and require appropriate multidisciplinary assessment for the procedure, comprehensive patient education and ongoing care, as well as safe and standardized surgical procedures. National guidelines for bariatric surgery need to be developed for people with Type 2 diabetes and a BMI of 35 kg/m² or more.

scholarly journals Comparative effectiveness of bariatric surgery vs. nonsurgical treatment of type 2 diabetes among severely obese adults

2013 ◽  
Vol 7 (4) ◽  
pp. e258-e268 ◽  
Author(s):  
David Arterburn ◽  
Andy Bogart ◽  
Karen J. Coleman ◽  
Sebastien Haneuse ◽  
Joe V. Selby ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Bariatric Surgery ◽  
Comparative Effectiveness ◽  
Nonsurgical Treatment ◽  
Obese Adults ◽  
Severely Obese

scholarly journals P924 Benefits of bariatric surgery on subclinical myocardial function using global longitudinal strain in severely obese individuals with and without diabetes

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
M Piche ◽  
M A Clavel ◽  
P Pibarot ◽  
P Poirier
Keyword(s):  
Type 2 Diabetes ◽  
Bariatric Surgery ◽  
Ejection Fraction ◽  
Myocardial Function ◽  
Myocardial Dysfunction ◽  
Global Longitudinal Strain ◽  
Surgery Group ◽  
Severely Obese ◽  
Lv Ejection Fraction

Abstract Background/Introduction: The presence of subclinical myocardial disease confers an increased cardiovascular disease risk. The effects of bariatric surgery on subclinical myocardial function assessed using left ventricular (LV) global longitudinal strain (GLS) in severely obese individuals with preserved LV ejection fraction is unclear. Purpose To evaluate changes in subclinical LV myocardial function following bariatric surgery in obese individuals with and without diabetes. Methods Thirty-eight severely obese individuals [body mass index (BMI) >35kg/m2] with preserved LV ejection fraction (≥ 50%) who underwent bariatric surgery (Surgery group) (BMI 48 ± 7 kg/m2), 19 obese individuals managed conservatively (Cons. group) (BMI 47 ± 9 kg/m2), and 18 age and sex-matched non-obese controls (Non-obese group) were included. Echocardiography with GLS measurements was performed at the beginning of the study and at 6 months. Abnormal myocardial function was defined as a GLS >-17%. Results Mean age of obese patients was 42 ± 11, BMI 48 ± 8 kg/m2, and 82% were female. The percentage of total weight loss at 6 months after bariatric surgery (Surgery group) was 26.3 ± 5.2%. Body weight remains unchanged at 6 months in the Cons. group. Proportions of hypertension (61 vs. 30%, P = 0.0005), dyslipidemia (42 vs. 5%, P = 0.0001) and type 2 diabetes (40 vs. 13%, P = 0.002) were reduced in the Surgery group. At the beginning, severely obese patients (Surgery group) displayed subclinical myocardial dysfunction vs. non-obese controls (LV GLS, -17.3 ± 2.5 vs. -19.6 ± 1.7%, P = 0.003). Six months after bariatric surgery, the subclinical myocardial function was comparable between both groups (LV GLS, -19.2 ± 2.1 vs. -19.6 ± 1.7%, P = NS). 22 severely obese individuals (58%) in the Surgery group showed abnormal GLS, which normalized in 82% after bariatric surgery (P = 0.0001). On the contrary, half of severely obese individuals managed conservatively (n = 10, 53%) worsened their GLS during the follow-up (P = 0.002). Remission of type 2 diabetes 6 months after bariatric surgery was associated with improvement in GLS (-17.5 ± 2.6 vs. -18.6± 1.8%), whereas obese individuals with type 2 diabetes managed conservatively showed a worsening in their subclinical myocardial function during the follow-up (-18.0 ± 2.4 vs. -17.4 ± 1.7%). Conclusions A great proportion of severely obese individuals with preserved LV ejection fraction have subclinical myocardial dysfunction. Bariatric surgery in obese individuals was associated with significant improvements in the metabolic profile and in subclinical myocardial function.

Bariatric surgery to treat severely obese patients with type 2 diabetes: A consensus statement

2011 ◽  
Vol 5 (1) ◽  
pp. e71-e78 ◽  
Author(s):  
Paul Zimmet ◽  
Lesley Campbell ◽  
Robyn Toomath ◽  
Stephen Twigg ◽  
Gary Wittert ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Bariatric Surgery ◽  
Consensus Statement ◽  
Obese Patients ◽  
Severely Obese

123-OR: Effect of Surgical vs. Medical Therapy on Diabetic Kidney Disease (DKD) in Severely Obese Adolescents with Type 2 Diabetes (T2D)

Diabetes ◽  
2019 ◽  
Vol 68 (Supplement 1) ◽  
pp. 123-OR ◽  
Author(s):  
PETTER BJORNSTAD ◽  
KARA S. HUGHAN ◽  
MEGAN M. KELSEY ◽  
AMY SHAH ◽  
JANE L. LYNCH ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Kidney Disease ◽  
Medical Therapy ◽  
Diabetic Kidney Disease ◽  
Diabetic Kidney ◽  
Obese Adolescents ◽  
Severely Obese
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