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A1c And Bariatric Surgery

Gastric Bypass Surgery May Lower Diabetes Risks, But Also Carries Dangers

Gastric Bypass Surgery May Lower Diabetes Risks, But Also Carries Dangers

Gastric surgery may not only help people combat obesity: Evidence shows it can also help reduce diabetes risk factors. A new University of Minnesota study published in JAMA on June 5 reveals that mild to moderately obese patients with Type 2 diabetes had more improvements in their blood glucose, cholesterol and blood pressure after they underwent gastric bypass surgery, than patients who made lifestyle changes with medical counseling. About 35.7 percent of the U.S. adult population is obese, according to the Centers for Disease Control and Prevention. Obesity has been linked to heart disease, stroke, Type 2 diabetes, some cancers and some of the leading causes of preventable death. About 25.8 million people have diabetes in the U.S. as of 2010, the NIH reports. The vast majority of those people have Type 2 diabetes, which is when the body does not produce enough insulin or the cells do not use the insulin. Insulin is produced by the pancreas and is required for a process in which the body wants to use energy from glucose, or broken down sugars and starches obtained from food. The best treatment for Type 2 diabetes is weight loss, but controlling glucose levels, blood pressure and cholesterol are important as well, the study authors noted. However, the optimal way to manage all those factors remains unknown. Researchers looked at 120 participants who had a hemoglobin A1c (HbA1c) level of 8.0 percent or higher, body mass index (BMI) between 30.0 and 39.9 signifying they were obese, a C peptide level of more than 1.0 ng/mL, and Type 2 diabetes for at least six months. The subjects were divided into two groups and followed for a year. The first group underwent Roux-en-Y gastric bypass. The second group was instructed to change their lifestyle and have intensive medical mana Continue reading >>

A1c Too High For Surgery?

A1c Too High For Surgery?

This is my first time posting. I am still working on the requirements that the insurance company requires and hope to submit for approval in June to have surgery (RNY) this summer. I'm diabetic and I went to a nutritionist this past week and she told me that no surgeon would operate on me with my A1C as high as it currently is (8.7). Has anyone had their surgery postponed or canceled due to their blood sugar being too high? I'm going to work hard on getting my A1C down before the summer but this has me concerned. None of my other doctors have said this could delay the process. I'm doing this surgery hopefully to reverse my diabetes or at least get me off some of my meds. What are you eating, start reducing your sugars and drabs remember everything you eat turns into sugar, replace at least 1 meal with a Protein Drink you will see a huge difference in a month. I agree cut down your carbs and sugar intake. Stay away from juices very high in natural sugars. If you eat yogurt get plain and add your own sweetener to it and a little fruit. Protein shakes are great but read the label for ingredients and make sure there is not sugar in it. If you are going to make your own shakes then I recommend Jay Robb whey Protein powder made with stevia. It comes in vanilla , strawberry and chocolate . You can find it at a Whole foods, Amazon , eBay or directly from the company. If you want some flavors added to it I recommend Toscani sugar free syrups made with Splenda. You can find them at World Market, Amazon, eBay or directly for Toscani. These are just a few suggestions of what I would do. I had diabetes and was on 2 types of diabetes medicine prior to surgery. During the 6 month medically monitored weight loss program mandated by my insurance company, I lost 20 pounds. As a result I Continue reading >>

The Rationale For Preoperative Glycemic Control In Bariatric Surgery

The Rationale For Preoperative Glycemic Control In Bariatric Surgery

The Rationale for Preoperative Glycemic Control in Bariatric Surgery Dr. Youdim is Medical Director, Comprehensive Weight Loss Center, Cedars Sinai Medical Center, Los Angeles, California and Assistant Clinical Professor of Medicine, David Geffen School of Medicine, University of California Los Angeles, California. Dr. Youdim has no financial disclosures relevant to the content of this article. The incidence of type 2 diabetes increases incrementally with rising body mass index. Bariatric surgery induces remission of diabetes through weight loss and weight independent effects. Studies support the role of strict long-term glycemic control, as reflected by HbA1c, in reducing postoperative complications. A reasonable goal for preoperative glycemic control is a HbA1c of 7.0 or less. The Centers for Disease Control and Prevention (CDC) has estimated that the rate of diabetes in the United States has reached almost 24 million, which translates to nearly eight percent of the population. Another 57 million people are estimated to have pre-diabetes, a strong risk factor for the development of diabetes.[1] The relationship between type 2 diabetes and obesity is well documented as the incidence increases incrementally with rising body mass index (BMI).[2,3] Bariatric surgery induces remission of type 2 diabetes mellitus both through weight loss and weight-independent effects that are believed to be mediated through the release of incretins as in intestinal bypass procedures.[4] The favorable effects of bariartric surgery have been well established, and recently the American Diabetes Association endorsed bariatric surgery for treatment of type 2 diabetes.[5] It is likely that a greater number of patients with diabetes will be seeking treatment of this disease through bariatric sur Continue reading >>

Blood Test Hgb A1c - Pre-op Gastric Bypass - Thinner Times Forum

Blood Test Hgb A1c - Pre-op Gastric Bypass - Thinner Times Forum

Just got my blood test results. Hgb A1c too high at 9.2 need to be at 8 or less for the surgery to take place. Has anyone else had this problem? Just wondering how long it will take for Hgb Ac1 to drop (by cutting out all sugar), PCP was willing to retest in 30 days. I had this problem last summer but it was for a different surgery (to repair an abdominal scar with 2 incisional hernias). I was only on oral meds at that time. I stressed out, gained some weight, didn't work on the diabetes and ended up cancelling the surgery my self. Since then I started on insulin (in Jan) and within 6 weeks time I dropped from the 8's down to 6.1. If you aren't on insulin, maybe you might consider taking it in order to get your surgery. Just got my blood test results. Hgb A1c too high at 9.2 need to be at 8 or less for the surgery to take place. Has anyone else had this problem? Just wondering how long it will take for Hgb Ac1 to drop (by cutting out all sugar), PCP was willing to retest in 30 days. I wish you luck, The easiest and quickest way to lower A1c is to cut out carbs. If you are at <9 youre daily BG must me around 245 or so, that is way too high. Surgery or not, for your health you must work on it. The Hgb A1c test is an indicator of how well your diabetes is under control (or not) over the past several weeks. Most endocrinologists want their type 2 diabetic patients on oral meds to be under 6.5 to be considered 'controlled'. I am not a physician but I am a health care professional, and 9.2 seems to be on the high side to me. If your not on meds already, please go see a specialist. Surgeon: Dr Randal Baker; Dr Ronald Ford (TT/BL) Hospital: Spectrum Health; Blodgett Campus Yep, I had the same problem. I had to get mine down to 8 too before they would do surgery. Mine was highe Continue reading >>

Effect Of Preoperative Hemoglobin A1c On Bariatric Surgery Outcomes

Effect Of Preoperative Hemoglobin A1c On Bariatric Surgery Outcomes

Bariatric or metabolic surgery is increasingly used as an adjunct to the treatment of diabetes. Many studies have demonstrated surgery to be superior to medical management. However, many programs require that patients meet a target hemoglobin A1c (Hgb A1c) level. As a result, some patients are denied surgery due to an inability to achieve an arbitrary Hgb A1c level. We sought to understand the impact of preoperative A1c levels on perioperative outcomes, including diabetes resolution and weight loss. To access this article, please choose from the options below Continue reading >>

Diabetes - A1c Too High For Bypass Surgery

Diabetes - A1c Too High For Bypass Surgery

DiABETES - A1C too high for bypass surgery DiABETES - A1C too high for bypass surgery So I had my last bariatric appointment early January. I was asked by the diabetic nurse to get my A1C down from 10.2! I decided to give myself 8 weeks from January 1st, but so far have not been consistent. I was told to leave 8-12 weeks before going back to the lab for the A1C test. Life is crazy right now and I'm so not focused on the weight loss surgery or managing my sugars right now. I'm so unfocused, I feel like I should be on an insulin pump. Just venting, but if anyone has experience, please feel free to share with me. A1C is an average of your blood sugars over a 3 month period. It takes awhile to get it down. Mine was 8.8 when I had my first appt and I was told that I had to get it down to below 8 or the surgeon wouldn't operate. I was able to get it down to 7.8 in three months just in time for my surgery. Are you on insulin? I was on Lantus and Novalog and was put on Victoza to help get mine down. I also cut out sodas, Pasta , rice, potatoes - started logging everything I ate and cut down to 1200 calories a day. That, with increased exercise did the trick. I also managed to lose about 29 lbs before surgery, so it was a two-fer. It won't be easy for sure! A pump could help, but they are awfully expensive. Do you check your blood sugar in the am, before meals and a couple hours after meals? That really helps your Endocrinologist to adjust your meds so you can get tighter control. The better your A1C, the less chances of complications with the surgery and the faster your recovery the best of luck to you. You can do this - just keep your mind focused on the benefits long term I had read some posts on here about surgeons wanting people to lower their A1cs before surgery so I aske Continue reading >>

Effects Of Obesity Surgery And Type 2 Diabetes | Ndei

Effects Of Obesity Surgery And Type 2 Diabetes | Ndei

Metabolic effects of bariatric surgery in patients with moderate obesity and type 2 diabetes Kashyap SR, Bhatt DL, Wolski, et al. Metabolic effects of bariatric surgery in patients with moderate obesity and type 2 diabetes: analysis of a randomized control trial comparing surgery with intensive medical treatment. Diabetes Care. 2013;36:2175-2182. A1C improvement from baseline was seen in all treatment groups at 24 months in a metabolic substudy of the STAMPEDE trial. Mean baseline A1C was 9.7%. At 24 months, mean A1C was 8.4% with intensive medical therapy (n=17), 6.7% with gastric bypass (n=18), and 7.1% with sleeve gastrectomy (n=19; P<0.05 for each surgical group vs medical therapy). In the surgical groups vs the medical therapy group: Greater improvements seen in fasting plasma glucose, HDL-C, triglycerides, and high-sensitivity C-reactive protein Lower percentage of subjects using insulin Greater weight loss was seen in both the gastric bypass and sleeve gastrectomy groups compared with medical therapy at 12 and 24 months. Reduction in body weight, body mass index, and absolute change in total body fat percent was similar between the gastric bypass and sleeve gastrectomy groups at 24 months. The absolute reduction in truncal fat from baseline was greater among those who underwent gastric bypass (-15.9%) compared with those who underwent sleeve gastrectomy Greater increases in insulin sensitivity and beta-cell function at 24 months were seen in the gastric bypass group. Insulin sensitivity (median) at 24 months vs baseline Gastric bypass (n=9): 3.8 vs 1.4 (P<0.001) 2.7-fold increase Sleeve gastrectomy (n=10): 5.8 vs 5.3 1.2-fold increase Beta-cell function (median absolute change) at 24 months vs baseline Greater with gastric bypass vs medical therapy (oral disposi Continue reading >>

Effect Of Laparoscopic Roux-en-y Gastric Bypass Surgery On Hemoglobin A1c Levels In Diabetic Patients: A Matched-cohort Analysis - Sciencedirect

Effect Of Laparoscopic Roux-en-y Gastric Bypass Surgery On Hemoglobin A1c Levels In Diabetic Patients: A Matched-cohort Analysis - Sciencedirect

Volume 5, Issue 1 , JanuaryFebruary 2009, Pages 4-10 Effect of laparoscopic Roux-en-Y gastric bypass surgery on hemoglobin A1c levels in diabetic patients: a matched-cohort analysis Elevated hemoglobin A1c (HbA1c) values are known to increase the risk of diabetic retinopathy, nephropathy, and peripheral neuropathy. The current guidelines recommend maintaining HbA1c values at <7%. We assessed the effect of laparoscopic Roux-en-Y gastric bypass surgery (LRYGB) on HbA1c values in diabetic patients compared with a conventionally treated cohort. A retrospective review of a prospective bariatric database identified diabetic patients who had undergone LRYGB from 2001 to 2005. A cohort of conventionally treated obese (body mass index >35 kg/m2) diabetic patients was matched by age and gender. The inclusion criteria consisted of a preoperative/initial HbA1c and 2 postoperative/follow-up HbA1c values compiled from our institution's comprehensive electronic medical record system. The patients in the LRYGB cohort were also required to have had a 1-year postoperative weight recorded. Statistical analysis was performed using the Student t test. Each cohort consisted of 40 women (78.4%) and 11 men (21.6%). The mean age was 48.8 8.3 years for the surgical cohort and 48.2 8.3 years for the conventionally treated cohort. The mean body mass index was 47.7 5.7 kg/m2 preoperatively for the surgical cohort and 45.1 5.7 kg/m2 initially for the conventionally treated cohort. The mean preoperative/initial HbA1c was 7.5% 1.4% and 7.0% 1.1% for the surgical and conventionally treated groups, respectively. At 1 year, HbA1c results were available for 46 LRYGB and 41 conventionally treated patients. The corresponding mean HbA1c values were 5.8% 1.1% and 7.0% .9% (P = .001). At 3 years, the mean HbA Continue reading >>

Bariatric Surgery For Diabetes

Bariatric Surgery For Diabetes

New guidelines last week recommended surgery as Type 2 diabetes treatment for people who are obese, including some who are mildly obese. Is “metabolic surgery” something you should consider? The guidelines were approved by the American Diabetes Association, the International Diabetes Federation, and 43 other medical groups around the world. They were published in the June issue of the journal Diabetes Care. If you are heavy and have an HbA1c of 7.0 or above, your doctor may soon advise you to have one of these surgeries. You will be told the surgery will lower your blood sugar and your weight, which usually happens. You may not be told the negative effects. How do you decide? When performed to manage diabetes, bariatric or weight-loss surgery is known as “metabolic surgery.” The term covers Roux-en-Y “gastric bypass” surgeries, which reduce your stomach to a small pouch and plug it into the middle of the small intestine. It also includes “sleeve gastrectomy,” in which the deep part of the stomach is removed and the rest stapled together into a sleeve shape. Wrapping a band around the stomach to shrink it (“gastric banding“) is also now considered metabolic surgery. There are other surgeries that restructure the bowel in different ways, which I’ll write about next week. Surgeons have been pleased to learn that their weight-loss operations also lower blood sugars, though they are working to fully understand how that happens. It’s probably not the weight loss. Often, the improvements in diabetes numbers come long before significant weight loss occurs. A conference in Rome in 2007 reported that people were getting off their diabetes medications and lowering their HbA1c scores after surgery. Eight years later, a follow-up conference in London decided Continue reading >>

Preoperative A1c And Clinical Outcomes In Patients With Diabetes Undergoing Major Noncardiac Surgical Procedures

Preoperative A1c And Clinical Outcomes In Patients With Diabetes Undergoing Major Noncardiac Surgical Procedures

OBJECTIVE To evaluate the relationship between preoperative A1C and clinical outcomes in individuals with diabetes mellitus undergoing noncardiac surgery. RESEARCH DESIGN AND METHODS Data were obtained from the National Surgical Quality Improvement Program database and the Research Patient Data Registry of the Brigham and Women’s Hospital. Patients admitted to the hospital for ≥1 day after undergoing noncardiac surgery from 2005 to 2010 were included in the study. RESULTS Of 1,775 patients with diabetes, 622 patients (35%) had an A1C value available within 3 months before surgery. After excluding same-day surgeries, patients with diabetes were divided into four groups (A1C ≤6.5% [N = 109]; >6.5–8% [N = 202]; >8–10% [N = 91]; >10% [N = 47]) and compared with age-, sex-, and BMI-matched nondiabetic control subjects (N = 888). Individuals with A1C values between 6.5 and 8% had a hospital length of stay (LOS) similar to the matched control group (P = 0.5). However, in individuals with A1C values ≤6.5 or >8%, the hospital LOS was significantly longer compared with the control group (P < 0.05). Multivariate regression analysis demonstrated that a higher A1C value was associated with increased hospital LOS after adjustments for age, sex, BMI, race, type of surgery, Charlson Comordity Index, smoking status, and glucose level on the day of surgery (P = 0.02). There were too few events to meaningfully evaluate for death, infections, or readmission rate. CONCLUSIONS Our study suggests that chronic hyperglycemia (A1C >8%) is associated with poor surgical outcomes (longer hospital LOS). Providing a preoperative intervention to improve glycemic control in individuals with A1C values >8% may improve surgical outcomes, but prospective studies are needed. Diabetes mellitus i Continue reading >>

Aace: Bariatric Surgery May Just Mask Diabetes

Aace: Bariatric Surgery May Just Mask Diabetes

AACE: Bariatric Surgery May Just Mask Diabetes by Kristina Fiore Kristina Fiore, Staff Writer, MedPage Today Explain that fasting blood sugar and HbA1c results after bariatric surgery may be inadequate for detecting diabetes, as postprandial blood glucose may tell a different story. Note that this study was published as an abstract and presented at a conference. These data and conclusions should be considered preliminary until published in a peer-reviewed journal. BOSTON -- Bariatric surgery may appear to cure diabetes based on measurements such as fasting plasma glucose and hemoglobin A1c, but postprandial glucose may tell a different story, researchers here said. In a case report, a patient who had had bariatric surgery achieved fasting blood sugar and HbA1c results that allowed him to stop taking insulin, but he frequently had postprandial blood sugar scores above 200 mg/dL, according to Anna Marina, MD, and Dace Trence, MD, of the University of Washington in Seattle. They presented their findings at a press briefing here at the American Association of Clinical Endocrinologists meeting. "Fasting blood glucose and HbA1c are insufficient criteria to establish remission of diabetes after surgery," Marina said. "Glucose tolerance tests or continuous glucose monitoring should be considered to provide a better assessment of glycemic status in this group of patients." Bariatric surgery has increasingly been championed as a cure for type 2 diabetes, potentially through improvement in insulin resistance and secretion. Fasting plasma glucose and HbA1c often provide evidence of that conclusion. But, Marina said, while these results certainly improve diabetes outcomes, they shouldn't yet be called a cure. She bases her conclusions on a case report of a 55-year-old patient with Continue reading >>

Preoperative Hemoglobin A1c And Postoperative Glucose Control In Outcomes After Gastric Bypass For Obesity

Preoperative Hemoglobin A1c And Postoperative Glucose Control In Outcomes After Gastric Bypass For Obesity

Background: Hemoglobin A1c (HbA1c) is a reliable marker for long-term glycemic control in obese diabetic patients. Roux-en-Y gastric bypass improves HbA1c levels over time. However, it is not clear whether the preoperative HbA1c level is a predictor of the outcome in these patients. Our objectives were to understand the predictive capacity of the preoperative HbA1c level in gastric bypass patients at a single university-based Bariatric Center of Excellence.Methods: We performed a retrospective review of 468 charts from 2006 to 2009 of patients who had undergone Roux-en-Y gastric bypass. Using their preoperative HbA1c status, the patients were categorized and the postoperative outcomes compared.Results: Of the 468 patients reviewed, 310 (66.2%) had a HbA1c of <6.5% (group 1), 92 (19.4%) had a HbA1c of 6.5-7.9% (group 2), and 66 (14.1%) had a HbA1c level of >8.0% (group 3). No difference was found among the 3 groups in baseline body mass index, race, procedure type, length of stay, hospital cost, and smoking status. Groups 2 and 3 were associated with older age, male gender, and higher baseline creatinine. Groups 2 and 3 also had a proportionally greater inpatient postoperative blood glucose level. An elevated postoperative glucose level was independently associated with wound infection (P = .008) and acute renal failure (P = .04). Also, group 3 experienced worse outcomes, including less weight loss at 18 months and fewer diabetic remissions. Over time, however, the vast majority in all groups achieved excellent chronic glycemic control, with HbA1c <6.5% after Roux-en-Y gastric bypass.Conclusion: Poor preoperative glycemic control is associated with worse glucose level control postoperatively, fewer diabetic remissions, and less weight loss. An elevated mean postoperativ Continue reading >>

A1c Level Before Surgery

A1c Level Before Surgery

Is there an A1C level that you must be at before surgery(sleeve). I can 't remember if they gave me a number, I know that I have been seeing an endocrinologist to get mine under control. One surgeon told me (for another procedure) that I had to maintain a 95 morning sugar. I said, are you serious? I still haven't seen a 95 in the AM, but I have in the afternoon. Will likely have to get another A1C prior to surgery, crossing my fingers... The surgeons like to see your hemoglobin A1c under 8. The closer to 6 the better. Having elevated blood sugars can affect healing which is why they want the levels under better control Good luck billysbelly & ksangels on your life changing decision. I have not seen a 95 blood sugar in a long time......soon you will say the same.Yesterday mine was 62. Whoo Hoo!It will be great to welcome you to the new, healthy you! Your morning blood sugar can be deceiving. It is your A1C that is the true indicator. My doctor sent me off to a diabetes workshop 5 years ago because my fasting glucose was regularly around 135-140. The rest of the day I was absolutely normal. My A1C? In those 5 years has only been over 6 in the past year (6.3). I asked the nurse running the workshop what was going on and she explained that with some folks who are pre-diabetic, when they go too long without eating (overnight) and don't eat enough complex carbs to hold them over, your blood sugar drops, your pancreas believes you need insulin and you start putting it out there. Since I am insulin resistant, what my body produces is not being absorbed into my bloodstream and transmitted where it is needed, and my blood sugar level goes up. Eating something that is high in fiber and takes long to digest helps combat this. Can the dieticians back me up on this? I'd hate to be m Continue reading >>

Treatment Of Diabetes Prior To And After Bariatric Surgery

Treatment Of Diabetes Prior To And After Bariatric Surgery

Go to: Introduction Type 2 diabetes (T2DM) is a major health problem with increasing incidence in the Western world as well as in developing countries. The disease is chronic and the treatment involves lifestyle changes, oral antidiabetic drugs, and/or injections of insulin or glucagon-like peptide-1 (GLP-1) analogs as well as treatment for any ongoing hypertension and/or hyperlipidemia. Although the mortality from cardiovascular disease in diabetes seems to decline over time, it is still at least double compared to that in a nondiabetic population.1 Diabetes is associated with obesity; the more obesity, the greater the risk for T2DM. Current recommendations for bariatric surgery are based on body mass index [(BMI), body weight (kg)/length (m2)]. Body mass index >25 is classified as overweight, and BMI >30 is classified as obesity. Similar to diabetes, obesity is also associated with increased risk of morbidity and mortality. The total risk of premature death has been reported to be increased at least two-fold in patients with obesity compared with normal-weight subjects.2 Moreover, the risk of death from cardiovascular disease has been reported to be increased three- and five-fold in obese women and men, respectively, and there is an increased risk for several types of cancer.3 Treatment modalities for obesity include lifestyle changes, diet regimens, pharmacological treatment, and bariatric surgery. Of these, surgery is the most efficient alternative and has been demonstrated to be associated with maintained weight reduction as well as with effects on obesity-associated conditions such as T2DM. Today, the most commonly used limits to qualify for bariatric (weight-reducing) surgery in Europe as well as in the United States are a BMI of 35 with comorbidity and 40 withou Continue reading >>

Is Weight Loss Surgery The Answer For Diabetes?

Is Weight Loss Surgery The Answer For Diabetes?

With commentary by Anita P. Courcoulas MD, MPH, FACS, professor of surgery and director of minimally invasive bariatric & general surgery at the University of Pittsburgh Medical Center Is weight-loss surgery better than nutrition and physical activity alone for reversing type 2 diabetes? That controversial question has occupied researchers, doctors, insurers and people with diabetes for more than a decade. Now, a small yet well-designed study seems to have the answer: Surgery. University of Pittsburgh researchers randomly assigned 61 obese women and men with type 2 diabetes to receive gastric bypass surgery, an adjustable gastric band or an intensive lifestyle change program. Study volunteers were tracked closely for three years, as scientists monitored their weight, fasting blood sugar, A1c levels (a test of long-term blood sugar control) and use of insulin and other diabetes medications. The results: More weight (and fat) lost: Gastric bypass recipients lost an average of 25% of their body weight (and nearly 11% of their body fat), gastric band wearers dropped 15% of their weight (and 5.6% of their body fat) and lifestyle group members lost 5.7% of their weight and 3% of their body fat. People in the gastric bypass also saw their waist size shrink the most, an indicator that they’d lost the most visceral fat – the kind that packs around internal organs and contributes to blood sugar processing problems. Lower blood sugar: People in the gastric bypass group saw fasting blood sugar drop 66 mg/dL and their A1c levels fall 1.4%. In comparison, gastric band recipients got a 35-point reduction in fasting blood sugar and a 0.8% reduction in A1c levels. For the lifestyle-only group, fasting blood sugar fell an average of about 28 mg/dL but A1c levels rose slightly. Less d Continue reading >>

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