Bariatric Surgery Outcomes in Patients with Latent Autoimmune Diabetes of the Adult

Bariatric surgery is a very effective treatment for obesity-associated type 2 diabetes. However, the benefits of bariatric surgery in patients with obesity and autoimmune diabetes, such as type 1 diabetes and latent autoimmune diabetes in adults (LADA), are controversial. We report 3 female patients with obesity and LADA who underwent laparoscopic Roux-en-Y gastric bypass >10 years ago. The patients were diagnosed with LADA both 1 and 9 years before (n = 2) or 11 years after the surgery (n = 1). Patients preoperative body mass index ranged from 36 to 47 kg/m2 and improved to 23–37 kg/m2 in the last follow-up visit, 10–15 years after surgery. Daily insulin dose also decreased from an average of 0.68 to 0.45 IU/kg in those patients treated with insulin before bariatric surgery. Only one patient developed diabetes-related target organ damage. This study shows that patients with LADA depict remarkable reduction of body weight and insulin requirements over long-term after bariatric surgery. So, LADA should not be considered a contraindication for bariatric surgery yet should only be recommended for patients with concomitant obesity with the primary aim of achieving sustained weight loss.

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Latent Autoimmune Diabetes in Adults Presenting as Diabetes "Recurrence" After Bariatric Surgery: A Case Report

Diabetes Care ◽

10.2337/dc13-0810 ◽

2013 ◽

Vol 36 (8) ◽

pp. e120-e120 ◽

Cited By ~ 5

Author(s):

S. B. Manning ◽

A. Pucci ◽

R. L. Batterham ◽

N. Finer

Keyword(s):

Bariatric Surgery ◽

Case Report ◽

Autoimmune Diabetes ◽

Latent Autoimmune Diabetes ◽

Diabetes Recurrence

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Autonomous and Continuous Adaptation of a Bihormonal Bionic Pancreas in Adults and Adolescents With Type 1 Diabetes

The Journal of Clinical Endocrinology & Metabolism ◽

10.1210/jc.2013-4151 ◽

2014 ◽

Vol 99 (5) ◽

pp. 1701-1711 ◽

Cited By ~ 83

Author(s):

Firas H. El-Khatib ◽

Steven J. Russell ◽

Kendra L. Magyar ◽

Manasi Sinha ◽

Katherine McKeon ◽

...

Keyword(s):

Type 1 Diabetes ◽

Glycemic Control ◽

Controlled Trial ◽

Insulin Dose ◽

Total Daily Dose ◽

Insulin Requirements ◽

Daily Insulin Dose ◽

And Shifts ◽

The Impact

Context: A challenge for automated glycemic control in type 1 diabetes (T1D) is the large variation in insulin needs between individuals and within individuals at different times in their lives. Objectives: The objectives of the study was to test the ability of a third-generation bihormonal bionic pancreas algorithm, initialized with only subject weight; to adapt automatically to the different insulin needs of adults and adolescents; and to evaluate the impact of optional, automatically adaptive meal-priming boluses. Design: This was a randomized controlled trial. Setting: The study was conducted at an inpatient clinical research center. Patients: Twelve adults and 12 adolescents with T1D participated in the study. Interventions: Subjects in each age group were randomized to automated glycemic control for 48 hours with or without automatically adaptive meal-priming boluses. Main Outcome Measures: Mean plasma glucose (PG), time with PG less than 60 mg/dL, and insulin total daily dose were measured. Results: The 48-hour mean PG values with and without adaptive meal-priming boluses were 132 ± 9 vs 146 ± 9 mg/dL (P = .03) in adults and 162 ± 6 vs 175 ± 9 mg/dL (P = .01) in adolescents. Adaptive meal-priming boluses improved mean PG without increasing time spent with PG less than 60 mg/dL: 1.4% vs 2.3% (P = .6) in adults and 0.1% vs 0.1% (P = 1.0) in adolescents. Large increases in adaptive meal-priming boluses and shifts in the timing and size of automatic insulin doses occurred in adolescents. Much less adaptation occurred in adults. There was nearly a 4-fold variation in the total daily insulin dose across all cohorts (0.36–1.41 U/kg · d). Conclusions: A single control algorithm, initialized only with subject weight, can quickly adapt to regulate glycemia in patients with TID and highly variable insulin requirements.

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Vitamin D status in Egyptian children with type 1 diabetes and the role of vitamin D replacement in glycemic control

Journal of Pediatric Endocrinology and Metabolism ◽

10.1515/jpem-2016-0292 ◽

2017 ◽

Vol 30 (4) ◽

Cited By ~ 10

Author(s):

Mona Hafez ◽

Mona Hassan ◽

Noha Musa ◽

Sahar Abdel Atty ◽

Sally Abdel Azim

Keyword(s):

Vitamin D ◽

Type 1 Diabetes ◽

Glycemic Control ◽

Insulin Dose ◽

Insulin Metabolism ◽

Insulin Requirements ◽

Daily Insulin Dose ◽

Egyptian Children ◽

High Glucose Level

AbstractBackground:The association of low serum 25 hydroxy cholecalciferol (25OHD) levels with high glucose level and diminished insulin sensitivity suggests that vitamin D (VD) may modulate insulin metabolism. The aim of the study was to screen for vitamin D deficiency (VDD) in pediatric patients with type 1 diabetes (T1D) and study the effect of VD supplementation on their glycemic control and insulin requirements.Methods:A prospective cohort study including 50 patients with T1D. VD level was assessed initially and after 3 months of VD supplementation (in those with VDD). HbAResults:Fifty patients with T1D were included with mean diabetes duration of 4.11±2.34 years. VD level ranged from 0.2 to 33 ng/mL. VD status correlated significantly with daily insulin dose (p=0.030, r=0.306) and HbAConclusions:VD was highly prevalent in Egyptian T1D patients. VD supplementation improved glycemic control at 3 months after therapy with no reduction in insulin requirements.

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Liraglutide as Adjunct to Insulin Treatment in Patients with Type 1 Diabetes: A Systematic Review and Meta-analysis

Current Diabetes Reviews ◽

10.2174/1573399815666190614141918 ◽

2020 ◽

Vol 16 (4) ◽

pp. 313-326 ◽

Cited By ~ 5

Author(s):

Patoulias Dimitrios ◽

Doumas Michael ◽

Kotsis Vasilios ◽

Stavropoulos Konstantinos ◽

Imprialos Konstantinos ◽

...

Keyword(s):

Systematic Review ◽

Type 1 Diabetes ◽

Meta Analysis ◽

Insulin Dose ◽

Grey Literature ◽

Body Weight Loss ◽

Severe Hypoglycemia ◽

Insulin Requirements ◽

Daily Insulin Dose

Background: A few Randomized Controlled Trials (RCTs) have evaluated the use of liraglutide in Type 1 Diabetes (T1D). Through the present systematic review and meta-analysis, we aim at critically appraising and summarizing those RCTs, providing precise effect estimates. Methods: We searched major databases and grey literature from their inception to October 2018, for RCTs with a duration ≥ 12 weeks, comparing liraglutide with placebo or any other comparator as adjunct to insulin in patients with T1D, investigating major efficacy and safety endpoints. This review is reported in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) statement. Results: We included 5 trials with 2,445 randomized participants. Liraglutide provided modest reductions in HbA1c, with liraglutide 1.8 mg producing the greatest decrease (MD = -0.24%, 95% CI -0.32 to -0.16, I2=0%). Significant weight reduction, up to 4.87 kg with liraglutide 1.8 mg was also observed (95% CI -5.31 to -4.43, I2=0%). Decrease in total daily insulin dose, primarily driven by a decrease in bolus insulin requirements, was demonstrated. Liraglutide decreased non-significantly the odds for severe hypoglycemia (OR=0.80, 95% CI 0.57-1.14, I2=0%), while it increased significantly the odds for gastrointestinal adverse events (for nausea, OR=4.70, 95% CI 3.68-6.00, I2=37%, and for vomiting, OR=2.50, 95% CI 1.54-4.72, I2=27%). A significant increase in heart rate was also demonstrated. No association with diabetic ketoacidosis or malignancies was identified. Conclusion: In patients with T1D, liraglutide might prove be an adjunct to insulin, improving glycemic control, inducing body weight loss and decreasing exogenous insulin requirements and severe hypoglycemia.

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Latent autoimmune diabetes in adults (LADA): usefulness of anti-GAD antibody titers and benefit of early insulinization

Arquivos Brasileiros de Endocrinologia & Metabologia ◽

10.1590/s0004-27302007000100009 ◽

2007 ◽

Vol 51 (1) ◽

pp. 52-58 ◽

Cited By ~ 20

Author(s):

Pedro Weslley S. Rosário ◽

Janice Sepulveda Reis ◽

Tiago Alvarenga Fagundes ◽

Maria Regina Calsolari ◽

Ricardo Amim ◽

...

Keyword(s):

Autoimmune Diabetes ◽

Insulin Dose ◽

Hdl Cholesterol ◽

Insulin Requirement ◽

C Peptide ◽

Beta Cell Failure ◽

Latent Autoimmune Diabetes ◽

Antibody Titers

OBJECTIVE: To determine the clinical and laboratory parameters and the progression to insulin requirement in two groups of LADA patients separated according to GADA titers, and to evaluate the benefit of early insulinization in patients at high risk of premature beta-cell failure (high GADA titers). METHODS: Among the diabetic adults seen at our service and screened for GADA at diagnosis, 54 were diagnosed with LADA and classified as having low (> 1 U/ml and < 17.2 U/ml) or high (> 17.2 U/ml) GADA titers. Fifty-four patients with type 2 diabetes (GADA-) were selected for comparison. In addition, 24 patients who had GADA titers > 20 U/ml and who were not initially insulinized were compared to 16 patients who were insulinized at diagnosis. RESULTS: Insulin resistance was higher in the GADA- group, followed by patients with low GADA titers. BMI and the frequency of arterial hypertension, elevated triglycerides and reduced HDL cholesterol were lower in the high GADA+ group, with no difference between the GADA- or low GADA+ groups. The high GADA+ group showed a greater reduction and lower levels of C-peptide and required insulin earlier during follow-up. Patients with GADA titers > 20 U/ml and insulinized early presented no significant variation in C-peptide levels, had better glycemic control and required a lower insulin dose than patients who were insulinized later. CONCLUSION: We agree that patients with LADA should be differentiated on the basis of GADA titers and that patients with GADA titers > 20 U/ml benefit from early insulinization.

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