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Surgical Management Of Diabetes Mellitus

A Surgical Approach To The Management Of Type Ii Diabetes Mellitus In Patients With A Bmi Between 25-35 Kg/m2

A Surgical Approach To The Management Of Type Ii Diabetes Mellitus In Patients With A Bmi Between 25-35 Kg/m2

You have reached the maximum number of saved studies (100). Please remove one or more studies before adding more. A Surgical Approach to the Management of Type II Diabetes Mellitus in Patients With a BMI Between 25-35 kg/m2 The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our disclaimer for details. ClinicalTrials.gov Identifier: NCT01197963 Recruitment Status : Terminated (IRB temporarily halted enrollment) The University of Texas Health Science Center, Houston Information provided by (Responsible Party): Brad Snyder, The University of Texas Health Science Center, Houston Study Description Study Design Arms and Interventions Outcome Measures Eligibility Criteria Contacts and Locations More Information The purpose of the study is to determine if by performing surgery we can cure Type II Diabetes. a sleeve gastrectomy, cutting out a portion of the stomach, which provides restriction of caloric intake and rapid gastric emptying. ileal transposition which involves repositioning a 150cm segment of the ileum into the jejunum causing improved glucose homeostasis. Procedure: Sleeve Gastrectomy and Ileal transposition Dietary Supplement: dietary and medical management A Surgical Approach to the Management of Type II Diabetes Mellitus in Patients With a BMI Between 25-35 kg/m2 Surgical treatment of one arm of the patient population. Procedure: Sleeve Gastrectomy and Ileal transposition Laparoscopic sleeve gastrectomy with ileal transposition Managed by endocrinologists using current medical therapy such as pills, injections and life style medication. Dietary Supplement: dietary and medical management dietary and medical routine m Continue reading >>

Type 1 Diabetes - Surgery

Type 1 Diabetes - Surgery

Some complications from type 1 diabetes are treated with surgery. For example, surgery to remove the vitreous gel (vitrectomy) may improve eye disease. For more information, see: When insulin isn't enough to keep blood sugar in your target range, a pancreas transplant might be an option. If it's successful, you may no longer have symptoms or need to treat diabetes. But you may still get complications from diabetes. If you already have complications, they may continue to get worse as time goes on. The success rate for pancreas transplants is improving because of new surgical techniques and new medicines. If you get a transplanted pancreas, you must take medicine to keep your body from rejecting the new organ. A pancreas transplant can be done at the same time as a kidney transplant . Research continues on pancreatic islet cell surgery. It involves inserting a small group of donated pancreas cells (islet cells) through a vein in your liver. After surgery, these cells begin making insulin. If they can make enough, you may no longer need insulin injections. Because the surgery is simpler than a pancreas transplant, there are usually fewer complications. But you must still take medicine to prevent rejection. Continue reading >>

Surgery In Diabetes Mellitus

Surgery In Diabetes Mellitus

Surgery In Diabetes Mellitus (DM) Walid Sayed Abdelkader Hassanen Specialist of internal Medicine * Hyperglycemia leads to impaired wound healing , deficient formation of granulation tissue. The chemotactic , phagocytic, and bacterial activity of the neutrophil is deficient , there is impaired hormonal host defense mechanism and abnormal complement function. * Metabolic sequelae in a surgical patient Increased glycogenolysis Increased gluconeogenesis hyperglycemia Decreased glucose utilization: Lipolysis with increased FFA Protein breakdown Increased nitrogen loss Increased urea production Increased sodium retension & potassium execretion and alteration of water metabolism ( increased ADH and increased aldosterone secretion ) free fatty acid (FFA) Antidiuretic hormone (ADH) * * Determinents of the management plan Type of DM Treatment, diet, oral antidiabetic drugs, insulin Metabolic status Vascular status: cardiac, renal, cerebral Surgery: Type: emergency or elective Minor or major procedure Type of anesthesia Post operative oral intake Pre-operative management Metabolic stress of surgery and anesthesia cause increased elaboration of catecholamins, glucocorticoids, glucagon, and growth hormone, all producing their metabolic effects resulting in hyperglycemia in the pre-operative period. The glycemic control is aimed to achieve a fasting plasma glucose of < 140 mg % and post prandial plasma glucose of < 200 mg %. Insulin dependent diabetic patients can be admitted 2-3 days prior to surgery to achieve satisfactory control. Cont. In NIDDM patients if the control is good with oral antidiabetic drugs , these drugs are stopped on the day of the surgery and intravenous fluids and insulin are given , if not are advised to stop drugs one week before surgery and admitted for insu Continue reading >>

Diabetes Mellitus Treatment

Diabetes Mellitus Treatment

In patients diagnosed with diabetes mellitus (DM), the therapeutic focus is on preventing complications caused by hyperglycemia. In the United States, 57.9% of patients with diabetes have one or more diabetes-related complications and 14.3% have three or more.[1] Strict control of glycemia within the established recommended values is the primary method for reducing the development and progression of many complications associated with microvascular effects of diabetes (eg, retinopathy, nephropathy, and neuropathy), while aggressive treatment of dyslipidemia and hypertension further decreases the cardiovascular complications associated macrovascular effects.[2-4] See the chapter on diabetes: Macro- and microvascular effects. Glycemic Control Two primary techniques are available to assess a patient's glycemic control: Self-monitoring of blood glucose (SMBG) and interval measurement of hemoglobin A1c (HbA1c). Self-Monitoring of Blood Glucose Use of SMBG is an effective method to evaluate short-term glycemic control. It helps patients and physicians assess the effects of food, medications, stress, and activity on blood glucose levels. For patients with type 1 DM or insulin-dependent type 2 DM, clinical trials have demonstrated that SMBG plays a role in effective glycemic control because it helps to refine and adjust insulin doses by monitoring for and preventing asymptomatic hypoglycemia as well as preprandial and postprandial hyperglycemia.[2,5-7] The frequency of SMBG depends on the type of medical therapy, risk for hypoglycemia, and need for short-term adjustment of therapy. The current American Diabetes Association (ADA) guidelines recommend that patients with diabetes self-monitor their glucose at least three times per day.[8] Those who use basal-bolus regimens should s Continue reading >>

Surgical Treatment Of Diabetes Mellitus By Islet Cell And Pancreas Transplantation

Surgical Treatment Of Diabetes Mellitus By Islet Cell And Pancreas Transplantation

The incidence and progression of chronic diabetic complications can be reduced by achieving normoglycaemia (box 1). Unfortunately the recent Diabetes Control and Complications Trial has shown that intensive, subcutaneous insulin regimens that improve blood glucose control puts the patient at three times the risk of developing severe hypoglycaemia.1 Intensive subcutaneous insulin regimens can never mimic the physiological fluctuations of in vivo insulin secretion. An alternative option to achieve near normoglycaemia is by transplantation of the whole pancreas (vascularised pancreas transplantation). Some would argue that this is perhaps a cumbersome approach when only the islet cells are needed to restore physiological levels of blood glucose, but perhaps more importantly pancreas transplantation (box 2) has an appreciable high rate of morbidity and mortality compared with kidney transplantation alone.2With these factors in mind investigators have tried to isolate and transplant individual islet of Langerhans cells. Box 1: Chronic diabetic complications Peripheral vascular disease. Coronary artery disease. Box 2: Pancreas transplantation Major surgical procedure. Higher rate of morbidity and mortality. Need for immunosuppression. Improves quality of life. Reverses some diabetic complications. 82% insulin independent at one year. Box 3: Islet transplantation Minor radiological procedure. Low morbidity and mortality. Intrahepatic implantation. Potential for no immunosuppression. Potential for use in young newly diagnosed diabetic patients. 14% insulin independent at one year. The advantages of islet cell transplantation (box 3) are that it requires only local anaesthesia and is a minor radiological procedure having minimal risk to the patient. Unfortunately the merits of b Continue reading >>

Surgical Management Of Diabetes Mellitus: Future Outlook

Surgical Management Of Diabetes Mellitus: Future Outlook

Surgical management of diabetes mellitus: future outlook 2018 Digital Science & Research Solutions, Inc. All Rights Reserved | About us Privacy policy Legal terms VPAT Citation Count is the number of times that this paper has been cited by other published papers in the database. The Altmetric Attention Score is a weighted count of all of the online attention Altmetric have found for an individual research output. This includes mentions in public policy documents and references in Wikipedia, the mainstream news, social networks, blogs and more. More detail on the weightings of each source and how they contribute to the attention score is available here . The Relative Citation Ratio (RCR) indicates the relative citation performance of an article when comparing its citation rate to that of other articles in its area of research. A value of more than 1.0 shows a citation rate above average. The articles area of research is defined by the articles that have been cited alongside it. The RCR is normalized to 1.0 for all articles. The Field Citation Ratio (FCR) is an article-level metric that indicates the relative citation performance of an article, when compared to similarly-aged articles in its subject area. A value of more than 1.0 indicates higher than average citation, when defined by FoR Subject Code, publishing year and age. The FCR is calculated for articles published in 2000 and later. The recent citations value is the number of citations that were received in the last two years. It is currently reset at the beginning of each calendar year. Patent citations is the number of times that this record has been cited by other published patents. Patents may be registered in several offices, and this may effect patent citation data. Continue reading >>

Surgical Treatment Of Diabetes Mellitus With Pancreas Transplantation.

Surgical Treatment Of Diabetes Mellitus With Pancreas Transplantation.

Surgical treatment of diabetes mellitus with pancreas transplantation. This article has been cited by other articles in PMC. OBJECTIVE. The authors compared results and morbidity in insulin-dependent diabetes mellitus (IDDM) patients undergoing preemptive pancreas transplantation (PTx) either before dialysis or before the need for a kidney transplant with IDDM patients undergoing conventional combined pancreas-kidney transplantation (PKT) after the initiation of dialysis therapy. SUMMARY BACKGROUND DATA. Combined PKT has become accepted generally as the best treatment option in carefully selected IDDM patients who either are dependent on dialysis or for whom dialysis is imminent. With improving results, the timing of PKT relative to the degree of nephropathy is evolving. However, it is not well established that the advantages of preemptive PTx can be achieved without incurring a detrimental effect on graft function or survival. METHODS. Over a 4-year study period, data on the following 3 recipient groups were collected prospectively and analyzed retrospectively: 1) 38 IDDM patients undergoing combined PKT while on dialysis (PKT:D); 2) 44 IDDM patients undergoing preemptive PKT before dialysis (PKT:ND); and 3) 20 IDDM patients undergoing solitary PTx. All patients underwent whole organ PTx with bladder drainage and were treated with quadruple immunosuppression. RESULTS. Actuarial 1-year patient survival is 100%, 98%, and 93%, respectively. One-year actuarial PTx survival (insulin-independence) is 92%, 95%, and 78%, respectively. The incidence of rejection, infection, operative complications, readmissions, and total hospital days was similar in the three groups. Long-term renal and pancreas allograft function and quality of life were similarly comparable. Rehabilitation 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 >>

[surgical Treatment Of Type 2 Diabetes Mellitus].

[surgical Treatment Of Type 2 Diabetes Mellitus].

[Surgical treatment of type 2 diabetes mellitus]. 1.Unidad de Terapia Intensiva, Fundacin Clnica Mdica Sur, Mxico DF, Mexico. [email protected] 2.>Unidad de Terapia Intensiva, Fundacin Clnica Mdica Sur, Mxico DF, Mexico. Cirugia y Cirujanos [01 Mar 2014, 82(2):219-230] Type: Review, Journal Article, English Abstract(lang: spa) Sustained remission of type 2 diabetes mellitus and significantly improved hyperlipidemia and arterial hypertension, control has been achieves in both lean and obese patient after bariatric surgery procedures or other gastrointestinal surgical procedures. It has been demonstrated that the metabolic effects of bariatric surgery in these patients derives not only in reducing weight and caloric intake, but also endocrine changes resulting from surgical manifestation gastrointestinal tract. In this article we review the clinical outcomes of such interventions (collectively called "metabolic surgery") and the perspectives on the role that these surgeries play in the treatment of patients with type 2 diabetes mellitus. Continue reading >>

Surgical Versus Medical Treatment Of Type 2 Diabetes Mellitus In Nonseverely Obese Patients: A Systematic Review And Meta-analysis

Surgical Versus Medical Treatment Of Type 2 Diabetes Mellitus In Nonseverely Obese Patients: A Systematic Review And Meta-analysis

Objective:To compare surgical versus medical treatment of type 2 diabetes mellitus (T2DM) remission and comorbidities in patients with a body mass index (BMI) less than 35 kg/m2. Background:Obesity surgery can achieve remission of T2DM and its comorbidities. Metabolic surgery has been proposed as a treatment option for diabetic patients with BMI less than 35 kg/m2 but the efficacy of metabolic surgery has not been conclusively determined. Methods:A systematic literature search identified randomized (RCT) and nonrandomized comparative observational clinical studies (OCS) evaluating surgical versus medical T2DM treatment in patients with BMI less than 35kg/m2. The primary outcome was T2DM remission. Additional analyses comprised glycemic control, BMI, HbA1c level, remission of comorbidities, and safety. Random effects meta-analyses were calculated and presented as weighted odds ratio (OR) or mean difference (MD) with 95% confidence intervals (95% CI). Results:Five RCTs and 6 OCSs (706 total T2DM patients) were included. Follow-up ranged from 12 to 36 months. Metabolic surgery was associated with a higher T2DM remission rate (OR: 14.1, 95% CI: 6.729.9, P < 0.001), higher rate of glycemic control (OR: 8.0, 95% CI: 4.215.2, P < 0.001) and lower HbA1c level (MD: 1.4%, 95% CI 1.9% to 0.9%, P < 0.001) than medical treatment. BMI (MD: 5.5 kg/m2, 95% CI: 6.7 to 4.3 kg/m2, P < 0.001), rate of arterial hypertension (OR: 0.25, 95% CI: 0.120.50, P < 0.001) and dyslipidemia (OR: 0.21, 95% CI: 0.100.44, P < 0.001) were lower after surgery. Conclusion:Metabolic surgery is superior to medical treatment for short-term remission of T2DM and comorbidities. Further RCTs should address the long-term effects on T2DM complications and mortality. Supplemental Digital Content is Available in the Continue reading >>

Type 2 Diabetes Mellitus Treatment & Management

Type 2 Diabetes Mellitus Treatment & Management

Approach Considerations The goals in caring for patients with diabetes mellitus are to eliminate symptoms and to prevent, or at least slow, the development of complications. Microvascular (ie, eye and kidney disease) risk reduction is accomplished through control of glycemia and blood pressure; macrovascular (ie, coronary, cerebrovascular, peripheral vascular) risk reduction, through control of lipids and hypertension, smoking cessation, and aspirin therapy; and metabolic and neurologic risk reduction, through control of glycemia. New abridged recommendations for primary care providers The American Diabetes Association has released condensed recommendations for Standards of Medical Care in Diabetes: Abridged for Primary Care Providers, highlighting recommendations most relevant to primary care. The abridged version focusses particularly on the following aspects: The recommendations can be accessed at American Diabetes Association DiabetesPro Professional Resources Online, Clinical Practice Recommendations – 2015. [117] Type 2 diabetes care is best provided by a multidisciplinary team of health professionals with expertise in diabetes, working in collaboration with the patient and family. [2] Management includes the following: Ideally, blood glucose should be maintained at near-normal levels (preprandial levels of 90-130 mg/dL and hemoglobin A1C [HbA1c] levels < 7%). However, focus on glucose alone does not provide adequate treatment for patients with diabetes mellitus. Treatment involves multiple goals (ie, glycemia, lipids, blood pressure). Aggressive glucose lowering may not be the best strategy in all patients. Individual risk stratification is highly recommended. In patients with advanced type 2 diabetes who are at high risk for cardiovascular disease, lowering Hb Continue reading >>

Surgical Treatment Of The Infected Diabetic Foot

Surgical Treatment Of The Infected Diabetic Foot

Surgical Treatment of the Infected Diabetic Foot Diabetic Foot Unit, Department of Surgery, Twenteborg Hospital Clinical Infectious Diseases, Volume 39, Issue Supplement_2, 1 August 2004, Pages S123S128, Jeff G. van Baal; Surgical Treatment of the Infected Diabetic Foot, Clinical Infectious Diseases, Volume 39, Issue Supplement_2, 1 August 2004, Pages S123S128, Foot infections are common in the diabetic patient. Early recognition, proper assessment, and prompt intervention are vital. A combination of surgery and antibiotics is mandatory in virtually all foot infections. The aim of surgery is 2-fold: first, to control the infection, and second, to attempt to salvage the leg. The eventual goal is always to preserve a functional limb. Foot deformities resulting from surgery may cause reulceration and a high morbidity. The surgical treatment of the infection largely consists of draining of pus and removal of all necrotic and infected tissue. Frequently, revascularization of the foot is needed to save the limb; thus, there must be a close cooperation with the vascular surgical service. The surgeon must have a thorough knowledge of foot anatomy and must be familiar with the defects in wound healing that are caused by diabetes. The outcome of surgery mainly depends on the skill, care, and experience of the surgeon. The best results are achieved within a multidisciplinary setting. Most deep infections are preceded by tissue breakdown, with local penetration of bacterial pathogens to the deeper tissues. In many cases, the extent of the infection is underestimated; in 10%15% of mild infections and in 50% of serious infections, an underlying contiguous osteitis can be demonstrated [ 1 ]. Familiarity with the several causative factors that lead to foot complications in diabetic pa Continue reading >>

Type 2 Diabetes

Type 2 Diabetes

Diabetes, defined as elevated blood sugar, is a disorder of metabolism, i.e., the way the body uses digested food for growth and energy. If not controlled, diabetes can be life threatening and associated with long-term complications that can affect every system and part of the body. Diabetes is classified into different types, based on various causes. Type 2 diabetes is by far the most common from of the disease, representing 80% to 90% of diabetes cases worldwide. Type 2 Diabetes and Obesity Type 2 diabetes can contribute to eye disorders and blindness, heart disease, stroke, kidney failure, amputation, and nerve damage. It can affect pregnancy and cause birth defects, as well. About 80 percent of persons with Type 2 diabetes are overweight. Of those, some are severely or morbidly or obese. A standard way to define overweight, obesity, and morbid obesity is with the body mass index (BMI), a measure of body fat based on height and weight. The average BMI is 25. Morbid obesity is defined as: A BMI of 40.0 or higher is considered severely (or morbidly) obese A BMI of 35.0 or higher in the presence of at least one other significant co-morbidity (diabetes, coronary artery disease, hypertension, sleep apnea, or degenerative joint disease) is also classified as morbid obesity. An individual can determine whether they are obese or morbidly obese using aBMI calculator. Why Bariatric Surgery? For most people who are simply overweight or obese, but not morbidly obese, diet and exercise are generally the best and safest way to reduce weight and health risks. The risks of bariatric surgery are thought to outweigh the risk of future medical problems and premature death. However, for men who are more than 100 pounds overweight or women more than 80 pounds, bariatric or weight-loss su Continue reading >>

Guidelines For Perioperative Management Of The Diabetic Patient

Guidelines For Perioperative Management Of The Diabetic Patient

Surgery Research and Practice Volume 2015 (2015), Article ID 284063, 8 pages 1Texas A&M Health Science Center, 8447 State Highway 47, Bryan, TX 77807, USA 2Division of Pulmonary, Critical Care & Sleep Medicine, Texas A&M Health Science Center, Corpus Christi, 1177 West Wheeler Avenue, Suite 1, Aransas Pass, TX 78336, USA Academic Editor: Roland S. Croner Copyright © 2015 Sivakumar Sudhakaran and Salim R. Surani. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Abstract Management of glycemic levels in the perioperative setting is critical, especially in diabetic patients. The effects of surgical stress and anesthesia have unique effects on blood glucose levels, which should be taken into consideration to maintain optimum glycemic control. Each stage of surgery presents unique challenges in keeping glucose levels within target range. Additionally, there are special operative conditions that require distinctive glucose management protocols. Interestingly, the literature still does not report a consensus perioperative glucose management strategy for diabetic patients. We hope to outline the most important factors required in formulating a perioperative diabetic regimen, while still allowing for specific adjustments using prudent clinical judgment. Overall, through careful glycemic management in perioperative patients, we may reduce morbidity and mortality and improve surgical outcomes. 1. Introduction Diabetes has classically been defined as a group of metabolic diseases characterized by hyperglycemia due to defects in insulin secretion, insulin action, or a combination of both [1]. The vast majority of di Continue reading >>

Perioperative Management Of Blood Glucose In Adults With Diabetes Mellitus

Perioperative Management Of Blood Glucose In Adults With Diabetes Mellitus

INTRODUCTION Diabetes mellitus is a common chronic disorder, affecting approximately 8 percent of the United States population [1]. Patients with diabetes have an increased incidence of cardiovascular disease and this, combined with the frequent microvascular complications of the disease, often translate into more surgical interventions. Careful assessment of patients with diabetes prior to surgery is required because of their complexity and high risk of coronary heart disease, which may be relatively asymptomatic compared with the nondiabetic population. Diabetes mellitus is also associated with increased risk of perioperative infection and postoperative cardiovascular morbidity and mortality [2,3]. One key aspect of the perioperative management is glycemic control; complex interplay of the operative procedure, anesthesia, and additional postoperative factors such as sepsis, disrupted meal schedules and altered nutritional intake, hyperalimentation, and emesis can lead to labile blood glucose levels. A rational approach to diabetes mellitus management allows the clinician to anticipate alterations in glucose and improve glycemic control perioperatively [4]. This review will discuss the preoperative evaluation of patients with diabetes, general goals of glycemic control, and management of blood glucose in the perioperative phase. The special circumstances of glucocorticoid therapy and hyperalimentation are also reviewed. More details regarding glucose control in hospitalized patients in general are found separately. (See "Management of diabetes mellitus in hospitalized patients" and "Glycemic control and intensive insulin therapy in critical illness".) PREOPERATIVE EVALUATION Clinical evaluation — The preoperative evaluation of any patient, including those with diabet Continue reading >>

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