Glycaemic control and weight loss with semaglutide in type 2 diabetes

2017 ◽  
Vol 5 (5) ◽  
pp. 315-317 ◽  
Author(s):  
Sten Madsbad ◽  
Jens J Holst
Keyword(s):  
Type 2 Diabetes ◽  
Weight Loss ◽  
Glycaemic Control

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.

Association Between Mobile Health App Engagement, and Weight Loss and Glycaemic Control in Adults with Type 2 Diabetes and Prediabetes

2021 ◽  
Author(s):  
Su Lin Lim ◽  
Melissa Hui Juan Tay ◽  
Kai Wen Ong ◽  
Jolyn Johal ◽  
Qai Ven Yap ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Weight Loss ◽  
Glycaemic Control ◽  
Mobile Health

Metabolic surgery in the treatment of type 2 diabetes mellitus

2011 ◽  
pp. 1818-1825
Author(s):  
David E. Cummings
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Weight Loss ◽  
Type 2 Diabetes Mellitus ◽  
Glycaemic Control ◽  
Gastrointestinal Surgery ◽  
Diabetes Remission ◽  
Obese Patients

Faced with the dual pandemics of obesity and type 2 diabetes mellitus, heath care providers require a broad array of treatment options. Diet, exercise, and medications remain the cornerstones of type 2 diabetes therapy, but long-term results with lifestyle modifications can be disappointing, and, despite an ever-increasing armamentarium of pharmacotherapeutics, adequate glycaemic control often remains elusive. Moreover, most diabetes medications promote weight gain, and using them to achieve tight glycaemic control introduces a proportionate risk of hypoglycaemia. In cases where behavioural/pharmacological strategies prove insufficient, gastrointestinal surgery offers powerful alternatives for obesity and type 2 diabetes treatment (Fig. 13.4.5.1). Among severely obese patients, bariatric operations cause profound, sustained weight loss, ameliorating obesity-related comorbidities and reducing long-term mortality (1–4). Operations involving intestinal bypasses exert particularly dramatic antidiabetes effects. For example, approximately 84% of obese patients with type 2 diabetes experience diabetes remission after a Roux-en-Y gastric bypass (RYGB), maintaining euglycaemia off diabetes medications for at least 14 years (1, 5–8). Mounting evidence indicates that these effects result not only from weight loss, but also from weight-independent antidiabetic mechanisms (9). Whereas diabetes is traditionally viewed as a relentless disease in which delay of end-organ complications is the major treatment goal, gastrointestinal surgery offers a novel endpoint: complete disease remission. Consequently, conventional bariatric procedures and experimental gastrointestinal manipulations are being used worldwide to treat type 2 diabetes in association with obesity, and, increasingly, among less obese or merely overweight patients (8). Gastrointestinal surgery also offers valuable research opportunities to improve knowledge of diabetes pathogenesis and help develop less invasive procedures and novel pharmaceuticals. This chapter discusses the effects of gastrointestinal operations on type 2 diabetes, and focuses on potential antidiabetic mechanisms that mediate those effects.

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