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Diabetes Treatment After Bariatric Surgery

Diet Shown To Be Critical Factor In Improving Type 2 Diabetes After Bariatric Surgery

Diet Shown To Be Critical Factor In Improving Type 2 Diabetes After Bariatric Surgery

Follow all of ScienceDaily's latest research news and top science headlines ! Diet shown to be critical factor in improving type 2 diabetes after bariatric surgery Patients with type 2 diabetes who consume a diet identical to the strict regimen followed after bariatric surgery are just as likely to see a reduction in blood glucose levels as those who undergo surgery, according to a new study. Patients with type 2 diabetes who consume a diet identical to the strict regimen followed after bariatric surgery are just as likely to see a reduction in blood glucose levels as those who undergo surgery, researchers at UT Southwestern Medical Center have found. "For years, the question has been whether it is the bariatric surgery or a change in diet that causes the diabetes to improve so rapidly after surgery," said Dr. Ildiko Lingvay, assistant professor of internal medicine and first author of the study published online in Diabetes Care. "We found that the reduction of patients' caloric intake following bariatric surgery is what leads to the major improvements in diabetes, not the surgery itself." The study followed 10 patients in a controlled, inpatient setting during two distinct periods. Initially they were treated only with the standard diet given to patients after bariatric surgery, while researchers measured effects on blood glucose levels. Several months later, the patients underwent the Roux-en-Y gastric bypass bariatric surgery and followed the same diet while the UT Southwestern research team again examined blood glucose levels. Patients received less than 2,000 calories total during each of these 10-day periods, which is the customary diet after gastric bypass surgery. Fasting blood glucose levels dropped 21 percent on average during the diet-only phase, and 12 perc Continue reading >>

Type 2 Diabetes Management In A Post-bariatric Surgery Patient

Type 2 Diabetes Management In A Post-bariatric Surgery Patient

Type 2 diabetes management in a post-bariatric surgery patient Type 2 diabetes management in a post-bariatric surgery patient A patient, aged 57 years, was admitted to the hospital to undergo gastric bypass surgery. He had a history of type 2 diabetes for ten years. Diabetes management in a pre-, post-bariatric surgery patient A patient, aged 57 years, was admitted to the hospital to undergo gastric bypass surgery. He had a history of type 2 diabetes for ten years. Pre-admission diabetes therapy included metformin 1000 mg at morning and bedtime, insulin glargine ( Lantus ) 70 units every day in the afternoon or evening, insulin aspart ( NovoLog ) 30 units plus sliding scale three times per day. The day prior to surgery, the patient reported taking metformin 1000 mg, insulin glargine 70 units, and insulin aspart 30 units with his evening meal. His hemoglobin A1c value was 8%, and it was taken just prior to surgery. The patient's blood glucose value on admission was 204 mg/dL. Throughout the surgery, blood glucose values ranged from 208 to 214 mg/dL. Throughout the day, the patient received a total of 8 units of insulin aspart in correction doses for noted hyperglycemia. The patient was instructed to take nothing by mouth on the day of surgery, and then was advised to start a bariatric clear liquid diet on post-operative day one, advancing as tolerated. This meal plan consisted of six small, liquid meals provided throughout the day with the goal of staying hydrated. On post-operative day two, blood glucose values ranged from 90 to 103 mg/dL. The patient continued to tolerate six small meals per day via a bariatric surgery diet.He was approved to dismiss from the hospital on post-operative day two. The patient was recommended to take a multivitamin with minerals daily aft Continue reading >>

Predictors Of Diabetes Remission After Bariatric Surgery In Asia - Sciencedirect

Predictors Of Diabetes Remission After Bariatric Surgery In Asia - Sciencedirect

Volume 35, Issue 2 , April 2012, Pages 67-73 Predictors of diabetes remission after bariatric surgery in Asia Author links open overlay panel Wei-JeiLeea Obesity and type II diabetes mellitus (T2DM) are closely related and difficult to control by current medical treatment. Bariatric surgery has been proposed for inadequately controlled T2DM in association with obesity. However, prediction of successful T2DM remission after surgery has not been clearly studied in Asian patients. This information might be helpful for applying gastrointestinal surgery as metabolic surgery for T2DM. This was a retrospective clinical study. From January 2002 to December 2008, 88 consecutive patients with morbid obesity, who were enrolled into a surgically supervised weight loss program, and who had T2DM before surgery with at least 1 year complete follow-up data were included. Sixty-eight (77.2%) patients received gastric bypass procedures, and the remaining 20 (22.8%) received restrictive procedures. We analyzed the available information during the initial evaluation of patients who were referred for bariatric surgery, by logistic regression analysis and data mining methods for predictors of successful diabetes remission after surgery. Overall, 68 (77.2%) of the 88 patients had remission of their T2DM 1 year after surgery. Patients in the bypass group had a higher remission rate than those in the restrictive group [59/68 (86.7%) vs. 9/20 (45.0%), p=0.000]. In univariate analysis, patients who had T2DM remission after surgery were younger, heavier, had a wider waist, less severe disease, shorter duration, and higher C-peptide levels than those without remission. Type of operation and T2DM duration remained independent predictors of success after multivariate logistical regression analysis ( Continue reading >>

Bariatric Surgery As A Treatment For Type 2 Diabetes

Bariatric Surgery As A Treatment For Type 2 Diabetes

by Tomasz Rogula, MD, PhD, Stacy Brethauer, MD, Bipan Chand, MD, and Phillip Schauer, MD To view a PDF version of this article, please click here. Almost 25 percent of Americans are obese, and between 3 and 5 percent of the adult population is morbidly obese, meaning they are 100 pounds or more above their ideal body weight. Morbid obesity is associated with the development of multiple life-threatening conditions, such as diabetes, hypertension (high blood pressure) and heart disease. Combating obesity has been approached through dieting, medications, behavioral modification and exercise. The only treatment for morbid obesity proven to be consistently effective in the long-run, however, is bariatric surgery. Diabetes Linked to Obesity Obesity is a very important factor in the development of type 2 diabetes. This disease is marked by high levels of sugar (glucose) in the blood and occurs when the body does not respond correctly to insulin, a hormone released by the pancreas. An obese person has double the risk of developing diabetes, and a severely obese person is at a tenfold increased risk. The risk of developing diabetes also increases with age, family history and obesity localized more in the abdomen (central obesity). Consumption of fatty and high-carbohydrate foods leads not only to obesity, but also to a higher amount of fatty acids in the blood and a buildup of lipids in the liver and skeletal muscles, causing resistance to insulin and consequently diabetes. Traditional Diabetes Therapy Diabetes needs to be treated to improve or normalize blood glucose levels, thereby preventing long-term complications like eye and kidney disease and damage to nerves and blood vessels. Normalized blood glucose reduces the risk of death, stroke, heart failure and other complicatio Continue reading >>

Metabolic And Bariatric Surgery And Type 2 Diabetes

Metabolic And Bariatric Surgery And Type 2 Diabetes

Did You Know? Someone in the world dies from complications associated with diabetes every 10 seconds. Diabetes is one of the top ten leading causes of U.S. deaths. One out of ten health care dollars is attributed to diabetes. Diabetics have health expenditures that are 2.3 times higher than non-diabetics. Approximately 90 percent of type 2 diabetes mellitus (T2DM), the most common form of diabetes, is attributable to excessive body fat. If current trends continue, T2DM or pre diabetic conditions will strike as many as half of adult Americans by the end of the decade. (according to the United HealthGroup Inc., the largest U.S. health insurer by sales). The prevalence of diabetes is 8.9 percent for the U.S. population but more than 25 percent among individuals with morbid obesity. Metabolic and bariatric surgery is the most effective treatment for T2DM among individuals who are affected by obesity and may result in remission or improvement in nearly all cases. Type 2 Diabetes Mellitus (T2DM) Type 2 diabetes(T2DM) is the most common form of diabetes, accounting for approximately 95 percent of all cases. Obesity is the primary cause for T2DM and the alarming rise in diabetes prevalence throughout the world has been in direct association increase rates of obesity worldwide. T2DM leads to many health problems including cardiovascular disease, stroke, blindness, kidney failure, neuropathy, amputations, impotency, depression, cognitive decline and mortality risk from certain forms of cancer. Premature death from T2DM is increased by as much as 80 percent and life expectancy is reduced by 12 to 14 years. Current therapy for type 2 diabetes includes lifestyle intervention (weight-loss, appropriate diet, exercise) and anti-diabetes medication(s). Medical supervision and strict adh Continue reading >>

Unveiling The “magic” Of Diabetes Remission After Weight-loss Surgery

Unveiling The “magic” Of Diabetes Remission After Weight-loss Surgery

An extraordinary thing happens to some patients with type 2 diabetes who undergo weight-loss surgery: Within days of the procedure, they improve their insulin production and need fewer or no diabetes medications. Although it’s well established that losing weight, especially around the waistline, improves pancreas function and insulin sensitivity, it generally takes 6 months to a year after bariatric surgery before a patient sheds a substantial number of pounds. Bruce M. Wolfe, MD, professor of surgery at Oregon Health and Science University School of Medicine, recalled one “remarkable” case in which a patient who required 400 daily units of insulin prior to gastric bypass surgery needed none on the day she was discharged from the hospital. Continue reading >>

Bariatric Surgery Enabled Stopping Diabetes Meds

Bariatric Surgery Enabled Stopping Diabetes Meds

Bariatric Surgery Enabled Stopping Diabetes Meds In French study, nearly half of obese patients with diabetes discontinued medications after surgery by Jeff Minerd Jeff Minerd, Contributing Writer, MedPage Today This article is a collaboration between MedPage Today and: Note that this large analysis of French bariatric surgery patients found that, compared with matched controls, the rate of discontinuation of diabetes medications was markedly higher in the bariatric surgery group. While discontinuation of diabetes medication is not necessarily a perfect marker of resolution of the disease, it is nevertheless a strong signal of surgical benefit. After bariatric surgery, significantly more obese patients with diabetes discontinued their medications, and fewer patients without diabetes initiated treatment, according to a nationwide population-based cohort study in France. Six years afterward, 49.9% of patients with diabetes who underwent bariatric surgery discontinued their medications, compared with just 9% of a matched non-surgical control group (P<0.001), said Jrmie Thereaux, MD, PhD, of La Cavale Blanche University Hospital in Brest, and colleagues. The main predictors for discontinuing diabetes meds were gastric bypass (odds ratio 16.7; 95% CI 13.0-21.4), sleeve gastrectomy (OR 7.30; 95% CI 5.50-9.50), and adjustable gastric banding (OR 4.30; 95% CI 3.30-5.60) compared with no bariatric surgery, the team reported online in JAMA Surgery . For patients without diabetes at baseline, the 6-year antidiabetes medication initiation rate was 1.4%, compared with 12% of the control group (P<0.001). The main factors linked with not starting medications were gastric bypass (OR 0.06; 95% CI 0.04-0.09), sleeve gastrectomy (OR 0.08; 95% CI 0.06-0.11), and adjustable gastric banding 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 >>

Diabetes Remission, Glycemic Control After Bariatric Surgery

Diabetes Remission, Glycemic Control After Bariatric Surgery

Objective Eligibility criteria for bariatric surgery in diabetes include BMI 35 kg/m2 and poorly controlled glycemia. However, BMI does not predict diabetes remission, and thus, predictors need to be identified. Research Design and Methods Seven hundred twenty-seven patients were included in a database merged from the Swedish Obese Subjects (SOS) study and two randomized controlled studies, with 415 surgical and 312 medical patients in total. Bariatric operations were divided into gastric only (GO) and gastric plus diversion (GD). Results Sixty-four percent of patients in the surgical arm and 15.0% in the medical arm experienced diabetes remission (P < 0.001). GO yielded 60% remission, and GD yielded 76% remission. The best predictors of diabetes remission were lower baseline glycemia and shorter diabetes duration. However, when operation type was considered, GD predicted a higher likelihood of remission and greater weight loss. Patients in remission (responders) lost more weight (25% vs. 17%) and waist circumference (18% vs. 13%) and experienced better insulin sensitivity than nonresponders. Conclusions Surgery is more effective than medical treatment in achieving diabetes remission and tighter glycemic control. Shorter diabetes duration, lower fasting glycemia before surgery, and GD versus GO procedures independently predict higher rates of remission, whereas baseline HbA1c and waist circumference predict improved glycemic control. The results show the advantage of an early operation together with better controlled glycemia on diabetes remission independently of BMI. The prospective, controlled Swedish Obese Subjects (SOS) study showed that the short-term rate of remission of diabetes after bariatric surgery is 72% compared with 21% in subjects treated with conventio Continue reading >>

Bariatric Surgery: American Diabetes Association

Bariatric Surgery: American Diabetes Association

Bariatric surgery (Gastric Bypass or Laparoscopic Gastric Banding) is sometimes considered for adults with a body mass index (BMI) above 35 and type 2 diabetes, especially if the diabetes is difficult to control with lifestyle changes and medicines. Although small trials have shown benefits to blood glucose control in patients with type 2 diabetes and high BMI, there isn't enough evidence for people with BMIs lower than 35. There are two main types of bariatric surgery: Gastric bypass surgery: shrinks the stomach (from the size of a fist to that of a thumb) and shortens the path food takes through the small intestine. This limits the number of calories absorbed. This change is permanent. Laparoscopic Gastric Banding also known as Lap-banding: a belt is wrapped around the stomach. This belt cinches the stomach so that it will feel full with less food. This change can be adjusted or reversed if needed. Because bariatric surgery is not regarded as a cure, it is recommended that individuals who have undergone a bariatric procedure continue to have the regular screenings that are recommended for people with diabetes, whether or not their glucose levels have normalized. In addition, they need careful ongoing assessments of blood glucose control conducted by their health care provider, as those with normal blood glucose levels after surgery are at risk for a return of hyperglycemia. Continue reading >>

Bariatric Surgery For People With Type 2 Diabetes And Prediabetes

Bariatric Surgery For People With Type 2 Diabetes And Prediabetes

Bariatric surgery for people with type 2 diabetes and prediabetes Q: What is type 2 diabetes? What is prediabetes? Type 2 diabetes is a chronic, degenerative disease that develops when the body cannot make enough, or properly use, insulin a hormone that helps regulate sugar (glucose) in the body. Prediabetes is a precursor to type 2 diabetes, defined by above-average glucose levels. Q: Do bariatric surgeries (Roux-en-Y gastric bypass, adjustable gastric banding and vertical sleeve gastrectomy) cure type 2 diabetes? A: Patients are often told weight loss surgeries will cure diabetes. Thats simply not true. However, individuals with type 2 diabetes or prediabetes and obesity may benefit from the modest weight loss achieved through surgery. After a gastric bypass or a sleeve gastrectomy, patients experience weight loss and changes in their gastrointestinal tract. Weight loss surgery causes profound changes in the incretins -- hormones in the gastrointestinal tract that cause insulin to be released. These changes lead to significant improvement in type 2 diabetes and can cause long-term changes in the pancreas that causes diabetes to go away. Decrease the amount of medications they need on a daily basis Postpone the onset of diabetes (for individuals with prediabetes) Q: How can weight loss surgery affect diabetes treatment? A: Modest weight loss can postpone the onset of diabetes for people with prediabetes. If diabetes is in the early stages, the individual might be able to stop taking diabetes medications (such as metfromin or insulin) for many years. For people with longstanding diabetes, taking oral medications, the effects of surgery may allow sugar levels to be controlled with food restrictions only. If the diabetes has been present for more than 10 years and progre Continue reading >>

Post-gastric Bypass Hypoglycemia: A Serious Complication Of Bariatric Surgery

Post-gastric Bypass Hypoglycemia: A Serious Complication Of Bariatric Surgery

Obesity is a rapidly increasing problem in the United States and worldwide, with more than 30% of adult Americans now affected. Unfortunately, we are lacking in effective therapies to promote significant weight loss. Although aggressive lifestyle modification is highly effective, it is plagued by difficulties with poor compliance, access and reimbursement. Medical therapy for obesity has limited efficacy and significant side effects, and with the recent withdrawal of sibutramine from the US market, there are limited options (See more info on this here). Therefore, more patients and providers are turning to bariatric surgery for the treatment of obesity and its comorbidities. Especially in the case of Roux-en-Y gastric bypass surgery, this is a highly effective therapy that can lead to significant weight loss and also improve metabolic parameters independent of weight loss. Roux-en-Y gastric bypass surgery involves attaching a small pouch of the upper stomach to the early part of the jejunum, thereby bypassing the majority of the stomach and the duodenum. This results in an increased sense of fullness and reduction in appetite, as well as alterations in hormonal release from the small intestine in response to food. This procedure has been found to lead to resolution of type 2 diabetes in up to 80% of patients. It has therefore been proposed as a potential “cure” for type 2 diabetes. Evaluating risks of surgery As with any therapy, Roux-en-Y gastric bypass surgery can result in adverse effects and complications. Although the immediate risks of morbidity and mortality from the surgery are low, the long-term risks associated with malabsorption and other complications are still being clarified as an increasing number of patients are undergoing this procedure. One long-te Continue reading >>

Diabetes Remission After Bariatric Surgery In T2d

Diabetes Remission After Bariatric Surgery In T2d

Objective The impact of bariatric surgeries on insulin-treated type 2 diabetes (I-T2D) in the general population is largely undocumented. We assessed changes in insulin treatment after bariatric surgery in a large cohort of I-T2D patients, comparing Roux-en-Y gastric bypass surgery (RYGB) with laparoscopic adjustable gastric banding (LAGB), controlling for differences in weight loss between procedures. Research Design and Methods Of 113,638 adult surgical patients in the Bariatric Outcomes Longitudinal Database (BOLD), 10% had I-T2D. Analysis was restricted to 5,225 patients with I-T2D and at least 1 year of postoperative follow-up. Regression models were used to identify factors that predict cessation of insulin therapy. To control for differences in weight loss patterns between RYGB and LAGB, a case-matched analysis was also performed. Results Of I-T2D patients who underwent RYGB (n = 3,318), 62% were off insulin at 12 months compared with 34% (n = 1,907) after LAGB (P < 0.001). Regression analysis indicated that RYGB strongly predicted insulin cessation at both 1 and 12 months postoperatively. In the case-matched analysis at 3 months, the proportion of insulin cessation was significantly higher in the RYGB group than in the LAGB group (P = 0.03), and the diabetes remission rate was higher at all time points after this surgery. RYGB was a weight-independent predictor of insulin therapy cessation early after surgery, whereas insulin cessation after LAGB was linked to weight loss. Conclusions I-T2D patients have a greater probability of stopping insulin after RYGB than after LAGB (62% vs. 34%, respectively, at 1 year), with weight-independent effects in the early months after surgery. These findings support RYGB as the procedure of choice for reversing I-T2D. Obesity a Continue reading >>

Bariatric Surgery: Many Can Come Off Insulin Long Term

Bariatric Surgery: Many Can Come Off Insulin Long Term

Bariatric Surgery: Many Can Come Off Insulin Long Term WASHINTON, DC Bariatric surgery can produce significant long-term metabolic benefits for insulin-treated patients with type 2 diabetes, new research indicates. Findings from the retrospective analysis of data for over 250 patients, which represents the largest series with the longest follow-up time to date, were presented November 2 here at Obesity Week 2017 by Ali Aminian, MD, associate professor of surgery at the Cleveland Clinic, Ohio. "Seven years after bariatric surgery, 44% of patients could come off insulin with their glycemic control at the target. Discontinuation of insulin can have significant impact on quality of life and healthcare costs," Dr Aminian told Medscape Medical News. For the 194 patients who underwent Roux-en-Y gastric bypass and 58 given sleeve gastrectomy, the surgeries also produced significant improvements in blood pressure and lipid profiles. And while gastric bypass was associated with more weight loss, less weight regain, and better short-term diabetes control, long-term diabetes control was similar between the two procedures. Asked to comment, session moderator Shanu N Kothari, MD, director of the minimally invasive bariatric surgery program at Gundersen Health System, La Crosse, Wisconsin, told Medscape Medical News that the new data "add to our body of literature that we have a metabolic intervention that's underutilized that gives far more durable and successful outcomes than medications." Dr Kothari added, "One message from this is that we should be intervening sooner. We know the chances of remission are much higher when we intervene with either procedure sooner as opposed to laterpreferably for patients with type 2 diabetes before they get to the point where they're on insulin, Continue reading >>

How Weight Loss Surgery Helps Type 2 Diabetes

How Weight Loss Surgery Helps Type 2 Diabetes

Weight loss surgery can make a big difference for people with type 2 diabetes. For some people, blood sugar levels get back to normal after surgery. Diabetes can be cured.That could mean you need less medication or none at all. Research shows improvements in type 2 diabetes after weight loss surgery. One long-term study tracked 400 people with type 2 diabetes. Six years after bariatric surgery, 62% showed no signs of diabetes. They also had better blood pressure, cholesterol, and triglyceride levels. In comparison, only 6% to 8% of people who took medicine, but didn’t have surgery, showed similar results. If you’re thinking about it, and you’re ready to make big changes to keep up the results, you’ll want to know if it’s right for you. First, your doctor will consider two things: Is your BMI 35 or higher? Have you tried to lose weight and keep it off without success? If so, he will give you a detailed checkup and ask you questions to see if you are physically and emotionally ready for the operation and the major changes you'll need to make. (You'll need to eat a lot less and make a healthy diet and exercise part of your life forever.) Depending on your particular case, other doctors may also get involved. For instance, if you have heart disease, your cardiologist would need to approve you for surgery. There are different kinds of operations. Some help you lose weight by shrinking the size of your stomach so you feel full after small meals. Others change the way your body absorbs calories, nutrients, and vitamins. Still others do both. Get to know what’s involved with each of these: 1. Gastric bypass (also called Roux-en-Y gastric bypass) The surgeon makes a small stomach pouch by dividing the top of the stomach from the rest of it. When you eat, food goes to Continue reading >>

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