Association Between Glycosylated Hemoglobin and Intentional Weight Loss in Overweight and Obese Patients With Type 2 Diabetes Mellitus

2012 ◽  
Vol 38 (3) ◽  
pp. 417-426 ◽  
Author(s):  
Ghanshyam Palamaner Subash Shantha ◽  
Anita Ashok Kumar ◽  
Scott Kahan ◽  
Lawrence J. Cheskin
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Weight Loss ◽  
Type 2 Diabetes Mellitus ◽  
Glycosylated Hemoglobin ◽  
Baseline Body Mass Index ◽  
Study Cohort ◽  
Obese Patients ◽  
Intentional Weight Loss

Purpose The purpose of this study is to assess the relationship between magnitude of weight loss and improvement in percentage A1C (A1C%) among overweight and obese patients with type 2 diabetes mellitus (DM) undergoing weight reduction. Methods Case records of patients enrolled in 2 university-based weight management programs were reviewed. Patients were sampled if they had a diagnosis of DM and had at least 1 documented A1C% reduction from their baseline value. Weight loss treatment was individualized and consisted of a calorie-restricted diet, a behavior modification plan, and a plan for increasing physical activity. Patient weights were measured at bimonthly visits. A1C% was measured every 3 months. Results Seventy-two patients formed the study cohort. Mean baseline body mass index was 35.1 kg/m2, mean age was 52.6 years, and 59% were males. Mean starting A1C% was 8.6. Patients achieved significant mean weight loss (10.7 kg) at study exit. Weight loss of 6.5 kg (4.5% of baseline body weight), 12.2 kg (8.7%), and 15.9 kg (10.3%) was required to reduce A1C% by 0.5, 1, and 1.5, respectively, and it took a mean of 5.6, 8.7, and 10.1 months, respectively, to achieve this. After adjustment for antidiabetic medication intake, for every 10% weight loss, the predicted reduction in A1C% was 0.81. Conclusions Intentional weight loss of 10% can potentially decrease A1C% by 0.81 among patients with type 2 DM. This finding may be clinically useful in encouraging and counseling a patient attempting weight loss.

scholarly journals Incretin-Based Therapies in Type 2 Diabetes Mellitus

2008 ◽  
Vol 93 (10) ◽  
pp. 3703-3716 ◽  
Author(s):  
Chee W. Chia ◽  
Josephine M. Egan
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Weight Loss ◽  
Type 2 Diabetes Mellitus ◽  
Evidence Synthesis ◽  
Glycosylated Hemoglobin ◽  
Cell Mass ◽  
New Drugs ◽  
Medline Search

Context: Glucagon-like peptide-1 (GLP-1) and glucose-dependent insulinotropic polypeptide are incretins secreted from enteroendocrine cells postprandially in part to regulate glucose homeostasis. Dysregulation of these hormones is evident in type 2 diabetes mellitus (T2DM). Two new drugs, exenatide (GLP-1 mimetic) and sitagliptin [dipeptidyl peptidase (DPP) 4 inhibitor], have been approved by regulatory agencies for treating T2DM. Liraglutide (GLP-1 mimetic) and vildagliptin (DPP 4 inhibitor) are expected to arrive on the market soon. Evidence Acquisition: The background of incretin-based therapy and selected clinical trials of these four drugs are reviewed. A MEDLINE search was conducted for published articles using the key words incretin, glucose-dependent insulinotropic polypeptide, GLP-1, exendin-4, exenatide, DPP 4, liraglutide, sitagliptin, and vildagliptin. Evidence Synthesis: Exenatide and liraglutide are injection based. Three-year follow-up data on exenatide showed a sustained weight loss and glycosylated hemoglobin (HbA1c) reduction of 1%. Nausea and vomiting are common. Results from phase 3 studies are pending on liraglutide. Sitagliptin and vildagliptin are orally active. In 24-wk studies, sitagliptin reduces HbA1c by 0.6–0.8% as monotherapy, 1.8% as initial combination therapy with metformin, and 0.7% as add-on therapy to metformin. Vildagliptin monotherapy lowered HbA1c by 1.0–1.4% after 24 wk. Their major side effects are urinary tract and nasopharyngeal infections and headaches. Exenatide and liraglutide cause weight loss, whereas sitagliptin and vildagliptin do not. Conclusions: The availability of GLP-1 mimetics and DPP 4 inhibitors has increased our armamentarium for treating T2DM. Unresolved issues such as the effects of GLP-1 mimetics and DPP 4 inhibitors on β-cell mass, the mechanism by which GLP-1 mimetics lowers glucagon levels, and exactly how DPP 4 inhibitors lead to a decline in plasma glucose levels without an increase in insulin secretion, need further research.

scholarly journals Evaluation of weight loss and metabolic profile of obese patients with type 2 diabetes mellitus (dm2) versus non-dm2 subjects, one and three years after bariatric surgery

2010 ◽  
Vol 23 (2) ◽  
pp. 100-104 ◽  
Author(s):  
Thiago Fraga Napoli ◽  
Mariana Furieri Guzzo ◽  
Douglas Kawashima Hisano ◽  
Paulo Gustavo Figueiredo Salgado Ribeiro ◽  
Vanessa Junqueira Guedes ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Bariatric Surgery ◽  
Weight Loss ◽  
Type 2 Diabetes Mellitus ◽  
Metabolic Profile ◽  
Weight Regain ◽  
Density Lipoprotein ◽  
Obese Patients

BACKGROUND: There is a debate over results obtained from type 2 diabetes mellitus (DM2) obese patients and non-DM2 patients, in reference to metabolic control and ponderal loss, after bariatric surgery. AIM: To evaluate weight loss and metabolic profile of obese patients with DM2 versus non-DM2 subjects, one and three years after bariatric surgery. METHODS: Data from 38 non-DM2 patients and 44 DM2 patients submitted to Roux-en-Y gastric-bypass were analysed retrospectively. For the pre-operatory, first and third year of post-operatory, were compared: weight, body mass index (BMI), fasting glucose (FG), high density lipoprotein (HDL) and triglycerides (TG). RESULTS: Preoperatively, both groups were statistically equivalent in regards to weight, BMI (P = 0.90) and HDL (P = 0.73). This was not the case when TG (P = 0.043) and FG (P<0.01) were analyzed. In PO1, both DM2 and non-DM2 groups showed a reduction in weight, BMI and TG, just as FG in the DM2 group (P < 0.05). HDL increased (P < 0.05) in PO1 in both groups. In the following period, between PO1 and PO3, only TG continued to decrease in the non-DM2 group (P = 0.039), while the other variables did not change. In the DM2 group mean A1c in PO3 was 6.2% +- 0.75 (P = 0.027). It was compared both group's post-operative data. HDL's and TG's variation between groups did not differ in PO1 or between PO1 and PO3. Weight in PO1 and PO3, just as BMI in PO1 and PO3, were not significantly different either. CONCLUSION: In PO1, weight loss and metabolic improvement was seen in both groups. This was sustained in PO3, with no significant weight regain or lipid/FG change. A1c found suggests a reasonable control of DM2 surgery. A trend towards a less intense weight loss could be noticed in the DM2 group (P = 0.053).

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.

scholarly journals Carotid Intima Media Thickness in Young Peruvians With Onset of Type 2 Diabetes Mellitus, an Early Marker of Vascular Compromise

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A285-A285
Author(s):  
Helard Andres Manrique ◽  
Pedro Nuñez
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Glycosylated Hemoglobin ◽  
Fasting Blood Glucose ◽  
Normal Weight ◽  
Laboratory Evaluation ◽  
Obese Patients ◽  
Obese Adolescents

Abstract Objective: To evaluate the relationship between the thickness of the carotid intima media (GIMT) with clinical and laboratory parameters in young people to identify asymptomatic endothelial dysfunction and prevent future vascular complications. Methods: This is a cross-sectional study of 81 adolescents from 10 to 18 years of age distributed in three groups: (i) 27 with onset of type 2 diabetes (DM2), (ii) 22 were non-diabetic obese; and (iii) 32 with normal weight, non-diabetic BMI from a National Reference Hospital in Lima, Peru. Laboratory evaluation consisted of fasting glucose levels, HbA1C, lipid profile, us-CRP, and Doppler ultrasound for measurement of the common carotid artery (right and left, both?). Results: In total 81 participants, 27 of them with a previous diagnosis of type 2 diabetes mellitus, of which 22 obese patients without the onset of type 2 diabetes mellitus and 32 normal weight without onset of type 2 diabetes mellitus, the median for age was 20, 19.5 and 20 years respectively, with a predominance of the female sex in the three groups; the median time of illness in years for the study group was 6 years (IQR 3–8) with DM2; Regarding treatment, metformin was the main drug used (20 patients) followed by sulfonylureas (glimepiride and glyburide, 9 patients), insulin (7 patients) and DPP4 inhibitors (vildagliptin and sitagliptin, 06 patients); Differences were found between the groups of patients with DM2, obese patients without DM2, and normal weight subjects without DM2, this difference being stronger in terms of body mass index (26.29, 31.35, 23.73 kg / m2, respectively); abdominal girth (91, 97.25, 78 cm, respectively); fasting blood glucose (126, 87.5, 94 mg / dl, respectively); glycosylated hemoglobin (7.77, 4.85, 4.97%, respectively), all of these with a p: 0.001; diastolic blood pressure (74, 68, 64 mmHg, respectively); and triglycerides (112, 112.5 and 65.5 mg / dl, respectively); The median IMT ± iqr was 0.430 ± 0.08 mm in adolescents with DM2; 0.420 ± 0.03 mm, in non-diabetic obese adolescents; and 0.405 mm ± 0.02 mm, in non-diabetic adolescents with normal weight. In general, lean, non-diabetic adolescents had a lower IMT than adolescents with DM2 (p = 0.003) and obese adolescents (p = 0.006). Conclusions: Adolescents with DM2 had a higher median IMT compared to lean, non-diabetic adolescents that reflect the onset of early vascular damage due to DM 2.

Reduced Calorie Intake and Weight Loss During Vagal Block (VBLOC Therapy) in Morbidly Obese Patients With Type 2 Diabetes Mellitus

2011 ◽  
Vol 140 (5) ◽  
pp. S-619
Author(s):  
James Toouli ◽  
Nicholas H. Wray ◽  
Jane Collins ◽  
Adele Coles ◽  
Katherine S. Tweden ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Weight Loss ◽  
Type 2 Diabetes Mellitus ◽  
Calorie Intake ◽  
Morbidly Obese ◽  
Obese Patients

scholarly journals Effects of Laparoscopic Roux-en-Y Gastric Bypass on Anthropometric Characteristics, Hypertension, Type 2 Diabetes Mellitus and Metabolic Syndrome: An Iranian Experience

2014 ◽  
Vol 3 (3) ◽  
pp. 167-75
Author(s):  
Morteza Ghoghaei ◽  
Elias Khajeh ◽  
Foad Taghdiri ◽  
Mohammad Mahdi Zamani ◽  
Soudeh Taghdiri ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Bariatric Surgery ◽  
Metabolic Syndrome ◽  
Weight Loss ◽  
Gastric Bypass ◽  
Type 2 Diabetes Mellitus ◽  
Morbidly Obese ◽  
Obese Patients

 Background: Surgically induced weight loss is a treatment option for the management of obesity and the related common disorders. This study evaluated the beneficial effects of bariatric surgery on metabolic profile and the prevalence of metabolic syndrome (MetS) among Iranian patients.Materials and Methods: A prospective observational study was performed on 26 morbidly obese patients scheduled for bariatric surgery, using laparoscopic Roux-en-Y gastric bypass (LRYGB). The parameters of hypertension, type 2 diabetes mellitus (T2DM), hyperlipidemia, MetS prevalence, and anthropometric measurements of Iranian patients, were recorded, at the preoperative visit and in follow-ups. The follow-up was performed for a median of 12 months, and the change in MetS prevalence and its componnts were assesed.Results: LRYGB induced a mean weight loss of 69.0±21.2%, after 12 months. Preoperative MetS was diagnosed in 21 patients (84%) and decreased to 6 patients (24%) after LRYGB (P=0.001). Likewise, the prevalence of hypertension was significantly decreased from 76% (pre-LRYGB values) to 20% (post-LRYGB values) (P=0.001). The prevalence of T2DM was also decreased from 20% to 8% (P=0.5).Conclusion: According to our results, RYGB produced a rapid and significant weight loss and improvement in hypertension and MetS within one year but there was a controversy about the improvement of T2DM, in Iranian morbidly obese patients.

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