Clinical Management of Type 2 Diabetes Mellitus after Bariatric Surgery

Abstract Bariatric surgery has emerged as an effective treatment for type 2 diabetes in the setting of obesity, with recent clinical trials demonstrating biochemical remission (i.e., euglycemia) in up to 40 % of subjects at 3 years post-surgery. Conversely, these trials also highlight that a significant proportion of individuals undergoing bariatric surgery experience residual diabetes (i.e., they do not achieve remission or experience diabetes recurrence). The management of residual diabetes following surgery requires personalized attention, yet limited evidence exists on which to base clinical decisions. Hence, we aim to review the evidence that does exist and propose clinical management strategies in patients with persistent hyperglycemia following bariatric surgery.
Source: Current Atherosclerosis Reports - Category: Cardiology Source Type: research

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ConclusionA high-level of suspicion is required to suspect, diagnose and treat post-RYGB complications. A bariatric on-call rota with appropriately trained personnel is essential.
Source: Obesity Surgery - Category: Surgery Source Type: research
AbstractBackgroundSleeve gastrectomy (SG) has become the most popular bariatric procedure. Although bariatric surgery is recommended for type 2 diabetes mellitus (T2DM) in Asian patients with BMI 27.5 –32.4 kg/m2, reported evidences, especially following SG, are still lacking.MethodsPatients ’ data from June 2016 to June 2018 that underwent SG as primary surgery at our setting were analyzed. Patients with T2DM, without insulin use and BMI 27.5–30 kg/m2, were our main criteria. Preoperative and postoperative parameters were as such: age, BMI, T2DM duration, anti-diabetic medications, fasting plas...
Source: Obesity Surgery - Category: Surgery Source Type: research
Abstract Background: More than half the diabetes-related health care costs in Canada relate to drug costs. We aimed to determine the effect of Roux-en-Y gastric bypass (RYGB) on the use of insulin and orally administered hypoglycemic medications in patients with diabetes. We also looked to determine overall cost savings with the procedure. Methods: We reviewed the bariatric clinic records of all patients with a confirmed diagnosis of type 2 diabetes mellitus who underwent RYGB between 2010/11 and 2014/15. Percentage estimated weight loss was recorded at 1 year, along with reductions in glycated hemoglobin (Hb...
Source: Canadian Journal of Surgery - Category: Surgery Authors: Tags: Can J Surg Source Type: research
Nature Reviews Endocrinology, Published online: 22 July 2019; doi:10.1038/s41574-019-0240-4Bariatric surgery often produces remission of hyperglycaemia in patients with coexistent obesity and type 2 diabetes mellitus, but the hyperglycaemia is prone to return years later. A prospective study demonstrates that therapy with a glucagon-like peptide 1 receptor agonist can reinstate normal glycaemic control in many of these patients.
Source: Nature Reviews Endocrinology - Category: Endocrinology Authors: Source Type: research
AbstractBariatric surgery (BS), including sleeve gastrectomy (SG), gastric bypass (GB), and ileal transposition (IT), is one of the approaches currently used for the correction of metabolic disturbances in type 2 diabetes mellitus (DM2) with obesity. However, the efficiency of these approaches and their impact on hypothalamic signaling and hormonal status in severe forms of DM2 without obesity remain poorly characterized. The aim of this work is to study the effect of IT, SG, and GB on insulin, leptin, ghrelin, and glucagon-like peptide-1 (GLP-1) levels in the blood and on the expression of the genes encoding the main comp...
Source: Advances in Gerontology - Category: Geriatrics Source Type: research
This study aims to determine the effect of type 2 diabetes mellitus and insulin therapy on non-alcoholic fatty liver disease in the patients with morbid obesity. MATERIAL AND METHODS: Clinical, anthropometric and laboratory data were analyzed together with intraoperative liver biopsies from morbidly obese patients undergoing bariatric surgery. RESULTS: 219 patients with morbid obesity were evaluated. Systemic arterial hypertension (55.9% vs. 33.8%, p = 0.004) and dyslipidemia (67.1% vs. 39.0%, p
Source: Annals of Hepatology - Category: Gastroenterology Tags: Ann Hepatol Source Type: research
Conclusionclinicians should be aware of such condition in patients with history of bariatric surgery who present with long-standing, intermittent abdominal pain.
Source: International Journal of Surgery Case Reports - Category: Surgery Source Type: research
Obesity, defined as a body mass index (BMI) of ≥ 30.0 kg/m2, is a major public health issue that contributes to significant disability, mortality, and health care costs (1,2). During the past 50 years, there has been a significant increase in the prevalence of obesity in the United States, which now affects more than one third of adults (3). P atients with obesity are at increased risk for the development of other serious medical conditions, such as type 2 diabetes mellitus (T2DM) (1,2). As such, there has been an increase in the prevalence of T2DM that mirrors that of obesity, with approximately 26 million adults in th...
Source: Journal of Vascular and Interventional Radiology : JVIR - Category: Radiology Authors: Tags: Commentary Source Type: research
AbstractIntroductionAvailable clinical data on the influence of baseline HbA1c postoperative morbidity and readmission after laparoscopic sleeve gastrectomy is scarce. This prompted us to conduct a multicenter retrospective study evaluating the influence of chronic hyperglycemia on postoperative course among patients undergoing laparoscopic sleeve gastrectomy (SG). We aimed to investigate the influence of baseline HbA1c levels on postoperative outcomes in patients after SG.Material and MethodsWe conducted a multicenter retrospective cohort study of consecutive patients who underwent SG from March 2017 to March 2018 in seve...
Source: Obesity Surgery - Category: Surgery Source Type: research
Conclusion: Decreased or normalized TSH levels after weight loss induced by RYGB might be mediated by the decline in leptin. There could be cross talk between adipose tissue and the HPT axis.Obes Facts 2019;12:272 –280
Source: Obesity Facts - Category: Eating Disorders & Weight Management Source Type: research
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