scholarly journals Severe obesity in a specialist type 2 diabetes outpatient clinic: an Australian retrospective cohort study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Arunav Thakur ◽  
Dharmesh Sharma ◽  
Bhavya Gupta ◽  
Nikitha Kramadhari ◽  
Rohit Rajagopal ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Bariatric Surgery ◽  
Severe Obesity ◽  
Sglt2 Inhibitor ◽  
Outpatient Service ◽  
Obesity Management ◽  
Group 13 ◽  
Significant Difference ◽  
Service Referral

Abstract Background Obesity is a major risk factor for the development of type 2 diabetes (T2DM) and its complications. Significant weight loss has been shown to improve glycaemia in people with T2DM and obesity. National and international guidelines recommend considering bariatric surgery for body mass index (BMI) ≥ 35 kg/m2. We assessed the proportion of people with T2DM meeting criteria for surgery, how many had been offered a bariatric/obesity service referral, and compared the characteristics of people with BMI ≥ 35 kg/m2 and BMI < 35 kg/m2. Methods Retrospective data were collected for all people with T2DM aged ≥18 years, attending a hospital specialist diabetes outpatient service over three calendar years, 2017–2019. Results Of 700 people seen in the service, 291 (42%) had BMI ≥ 35 kg/m2 (the “BMI ≥ 35 group”) and met criteria for bariatric surgery, but only 54 (19%) of them were offered referral to an obesity service. The BMI ≥ 35 group was younger than those with a BMI < 35 kg/m2 (56.1 ± 14.8 vs 61.4 ± 14.6 years, p < 0.001) (mean ± SD), with similar diabetes duration (11.0 ± 9.0 vs 12.3 ± 8.9 years, p = 0.078), and there was no significant difference in initial HbA1c (75 ± 27 vs 72 ± 26 mmol/mol, p = 0.118) (9.0 ± 2.5 vs 8.7 ± 2.4%) or proportion treated with insulin (62% vs 58%). There was more GLP1 agonist use in the BMI ≥ 35 group (13% vs 7%, p = 0.003) but similar rates of SGLT2 inhibitor use (25% vs 21%, p = 0.202). The BMI ≥ 35 group received more new medication and/or dose adjustments (74% vs 66%, p = 0.016). Only 29% in the BMI ≥ 35 kg group achieved HbA1c < 53 mmol/mol (7.0%). Conclusions In spite of frequently meeting the criteria for bariatric surgery and not achieving glycaemic targets, people with T2DM in this specialist clinic received limited medical or surgical management of their obesity. This study suggests opportunities for improvement in care of people with T2DM at several levels including increased referrals from T2DM services to weight management/bariatric services, as well as an increased use of GLP1 agonists and SGLT2 inhibitors where appropriate. Our data support the need to prioritise obesity management in the treatment of type 2 diabetes.

scholarly journals Severe Obesity in A Specialist Type 2 Diabetes Outpatient Clinic: An Australian Retrospective Cohort Study

2020 ◽  
Author(s):  
Arunav Thakur ◽  
Dharmesh Sharma ◽  
Bhavya Gupta ◽  
Nikitha Kramadhari ◽  
Rohit Rajagopal ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Bariatric Surgery ◽  
Severe Obesity ◽  
Sglt2 Inhibitor ◽  
Outpatient Service ◽  
Obesity Management ◽  
Group 13 ◽  
Significant Difference ◽  
Service Referral

Abstract Background Obesity is a major risk factor for the development of type 2 diabetes and its complications. Significant weight loss has been shown to improve glycaemia in people with type 2 diabetes (T2DM) and obesity. National and International guidelines recommend considering bariatric surgery for body mass index (BMI) ≥35 kg/m2. We assessed the proportion of people with T2DM meeting criteria for surgery, how many had been offered a bariatric/obesity service referral, and compared the characteristics of people with BMI≥35kg/m2 and BMI < 35 kg/m2.Methods Retrospective data were collected for all people with T2DM aged ≥18 years, attending a hospital specialist diabetes outpatient service over three calendar years, 2017–2019.Results Of 700 people seen in the service, 291 (42%) had BMI≥35kg/m2 (the “BMI≥35 group”) and met criteria for bariatric surgery, but only 54 (19%) of them were offered referral to an obesity service. The BMI≥35 group was younger than those with a BMI < 35 kg/m2 (56.1 ± 14.8 vs 61.4 ± 14.6 years, p < 0.001) (mean ± SD), with similar diabetes duration (11.0 ± 9.0 vs 12.3 ± 8.9 years, p = 0.078), and there was no significant difference in initial HbA1c (75 ± 27 vs 72 ± 26 mmol/mol, p = 0.118) (9.0 ± 2.5 vs 8.7 ± 2.4%) or proportion treated with insulin (62% vs 58%). There was more GLP1 agonist use in the BMI≥35 group (13% vs 7%, p = 0.003) but similar rates of SGLT2 inhibitor use (25% vs 21%, p = 0.202). The BMI≥35 group received more new medication and/or dose adjustments (74% vs 66%, p = 0.016). Only 29% in the BMI≥35kg group achieved HbA1c < 53 mmol/mol (7.0%).Conclusions In spite of frequently meeting the criteria for bariatric surgery and not achieving glycaemic targets, people with T2DM in this specialist clinic received limited medical or surgical management of their obesity. Our data support the need to prioritise obesity management in the treatment of type 2 diabetes.

Clinical efficacy of bariatric surgery versus liraglutide in patients with type 2 diabetes and severe obesity: a 12-month retrospective evaluation

2014 ◽  
Vol 52 (2) ◽  
pp. 331-336 ◽  
Author(s):  
M. Cotugno ◽  
G. Nosso ◽  
G. Saldalamacchia ◽  
G. Vitagliano ◽  
E. Griffo ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Bariatric Surgery ◽  
Clinical Efficacy ◽  
Severe Obesity ◽  
Retrospective Evaluation

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.

scholarly journals EP.WE.712Predictors of remission for type 2 diabetes mellitus after bariatric surgery: a systematic review and meta-analysis

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Gautam Kumar ◽  
Sangara N Narayanasamy ◽  
Vibha Ramesh ◽  
Ajay Aspari ◽  
Ashutosh O Gumber
Keyword(s):  
Diabetes Mellitus ◽  
Systematic Review ◽  
Type 2 Diabetes ◽  
Bariatric Surgery ◽  
Type 2 Diabetes Mellitus ◽  
Influential Factor ◽  
Cochrane Library ◽  
Type 2 Dm ◽  
Significant Difference

Abstract Aims Bariatric surgery has been implicated as a practical therapeutic approach to cure Type 2 Diabetes Mellitus. Hence, the present study aims to analyse the factors that can predict type2 diabetes remission after bariatric surgery and the recent literature to update information by systematic review. Methods Search strategy followed PICOS framework and PRISMA standards. PubMed, EMBASE, Cochrane Library, MEDLINE, and CINAHL databases were searched. SPSS version 19 and RevMan 5.0 software were utilised for statistical analysis. Result Five articles were eligible for inclusion from 2010 to November 2019. The mean age of the population in the remission group was younger (40.24 years) than the non-remission groups (p &lt; 0.02). Statistically, a significant difference (p &lt; 0.08) was also found with mean HbA1c in the remission group (7.78%) than the non-remission group (8.96%). Mean BMI and duration of DM were different in two groups, but statistical significance was not observed. Conclusion ABCD (Age, BMI, C-peptide and duration of type 2 DM) score has been widely used over the years for defining remission in type 2 DM following bariatric surgery. The current analysis statistically identified advanced age and HbA1c levels as an influential factor for non-remission. Though the difference in BMI and duration of DM noticed in two groups, it was not statistically significant. Our analysis is in agreement and the continuation of the review by Wang et al. (2015). He concluded that younger age group, shorter duration of type 2 DM and adequate glycemic control were responsible for remission after bariatric surgery.

scholarly journals Association Between Bariatric Surgery and Macrovascular Disease Outcomes in Patients With Type 2 Diabetes and Severe Obesity

JAMA ◽  
2018 ◽  
Vol 320 (15) ◽  
pp. 1570 ◽  
Author(s):  
David P. Fisher ◽  
Eric Johnson ◽  
Sebastien Haneuse ◽  
David Arterburn ◽  
Karen J. Coleman ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Bariatric Surgery ◽  
Severe Obesity ◽  
Macrovascular Disease ◽  
Disease Outcomes

P3753Does empagliflozin modulate the autonomic system among patients with type 2 diabetes and coronary artery disease? Insights from the Holter sub-study of the EMPA-Heart CardioLink-6 Randomised Trial

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
V Garg ◽  
S Verma ◽  
K A Connelly ◽  
A T Yan ◽  
A Sikand ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Coronary Artery Disease ◽  
Heart Rate ◽  
Coronary Artery ◽  
Randomised Trial ◽  
Sglt2 Inhibitor ◽  
Autonomic Tone ◽  
Significant Difference ◽  
Artery Disease

Abstract Introduction The mechanism behind how empagliflozin, a sodium-glucose co-transporter 2 (SGLT2) inhibitor, reduces all-cause and cardiovascular mortality among patients with type 2 diabetes (T2DM) and coronary artery disease (CAD) is unknown. Autonomic tone, as reflected by changes in heart rate variability (HRV), is an established prognosticator in patients with CAD and/or heart failure. Purpose To assess if empagliflozin treatment changes HRV in subjects with T2DM and CAD. Methods In the double-blind EMPA-Heart trial, 97 subjects with T2DM and CAD were randomised to empagliflozin 10 mg/day or placebo for 6 months and underwent 24-hour Holter monitoring at baseline and 6 months. Using automated algorithms, time and frequency HRV domain measures were obtained (standard deviation of NN intervals (SDNN); SD of the average NN intervals for each 5-minute segment (SDANN); root mean square of successive RR interval differences (rMSSD); % interval differences of successive NN intervals >50 ms (pNN50); ratio of low to high frequency (LF/HF)). Changes of these HRV parameters were calculated over 6 months. Between-group differences in HRV parameters were compared using ANCOVA. Results Complete Holter data (baseline and 6-month) were available for 68% (n=66) of the cohort. The average heart rate (HR) at baseline/6 months was 69.5±9.8 bpm/72.8±8.1 bpm and 76±10.4 bpm/76.5±10.6 in the placebo group and empagliflozin group, respectively. Both groups had similar changes in average HR over 6 months. Key Holter data are summarised in the table. SDNN and SDANN were higher in the placebo vs. empagliflozin group at 6 months; no significant difference was noted for all other measures. Empagliflozin 10 mg/day (n=33) Placebo (n=33) Adjusted difference between Empagliflozin and Placebo (ANCOVA) Baseline, Mean (SD) 6-month, Mean (SD) Baseline, Mean (SD) 6-month, Mean (SD) Mean, (95% CI) P-value SDNN (ms) 100.49 (43.74) 98.05 (38.86) 109.35 (30.02) 125.08 (43.83) −18.55 (−34.28, −2.82) 0.022 SDANN (ms) 86.84 (39.34) 83.76 (35.53) 94.70 (28.52) 118.28 (77.41) −20.24 (−37.27, −3.21) 0.021 rMSSD (ms) 27.00 (11.84) 27.22 (13.48) 28.00 (11.58) 27.17 (9.38) −1.23 (−6.02, 3.55) 0.608 pNN50 (%) 7.81 (7.59) 8.32 (9.51) 8.26 (7.8) 6.93 (5.35) 0.51 (−2.61, 3.62) 0.746 LF/HF ratio 1.63 (0.52) 1.65 (0.51) 1.53 (0.43) 1.83 (0.82) −0.08 (−0.38, 0.22) 0.602 Conclusions Among subjects with T2DM and CAD, changes in HRV over 6 months were similar in the empagliflozin and placebo arms suggesting that the mortality benefit conferred by empagliflozin is not associated with positive modulation of autonomic tone. Acknowledgement/Funding This trial was supported by an unrestricted investigator-initiated study grant from Boehringer Ingelheim.

Improvement of Type 2 Diabetes after Bariatric Surgery in a Patient with Severe Obesity

2011 ◽  
Vol 12 (1) ◽  
pp. 53
Author(s):  
Mi-Seon Shin ◽  
Joo Hui Kim ◽  
Jenie Yoonoo Hwang ◽  
Eun Hee Kim ◽  
Woo Je Lee ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Bariatric Surgery ◽  
Severe Obesity

scholarly journals Long-term outcomes of macrovascular diseases and metabolic indicators of bariatric surgery for severe obesity type 2 diabetes patients with a meta-analysis

PLoS ONE ◽  
2019 ◽  
Vol 14 (12) ◽  
pp. e0224828 ◽  
Author(s):  
Guoli Yan ◽  
Jinjin Wang ◽  
Jianfeng Zhang ◽  
Kaiping Gao ◽  
Qianqian Zhao ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Bariatric Surgery ◽  
Severe Obesity ◽  
Meta Analysis ◽  
Long Term Outcomes ◽  
Diabetes Patients

scholarly journals The Effect of Bariatric Surgery versus Intensive Medical Care on Prevention of Microalbuminuria in Patients with Type 2 Diabetes: 3 Year Experience of a Prospective Study

2021 ◽  
Vol 9 (B) ◽  
pp. 202-207
Author(s):  
Amin Soliman ◽  
Haythum Soliman ◽  
Mervat Naguib
Keyword(s):  
Type 2 Diabetes ◽  
Bariatric Surgery ◽  
Sleeve Gastrectomy ◽  
Prospective Study ◽  
Medical Care ◽  
Medical Therapy ◽  
Medical Group ◽  
Significant Difference ◽  
A Prospective Study

BACKGROUND: Bariatric surgery could improve diabetic kidney disease; however, the effect of surgery versus medical therapy on renal out comes needs further evaluation. AIM: The aim of the study was to investigate the effect of sleeve-gastrectomy versus intensive medical therapy on the prevention of albuminuria in patients with Type 2 diabetes mellitus (T2DM). METHODS: This is a prospective study of 33 patients with T2DM undergoing sleeve gastrectomy matched for age, sex, and duration of diabetes to 64 medically treated patients. Urinary albumin/creatinine ratio (uACR) was assessed before and 3–year after intervention. RESULTS: At baseline, there was no significant difference between surgical and medical group regarding body mass index (BMI), blood pressure, Hemoglobin A1c (HbA1c), or uACR. After 3 years of interventions the mean BMI (kg/m2) and HbA1c (%) became significantly lower in the surgical group compared to medical group. Although mean uACR (g/mg) increased after interventions compared to its levels before interventions in both surgical (11.7 ± 4.8 vs.18.2 ± 5.9) g/mg and medical (13.4 ± 4.5 vs.17.1 ± 6) g/mg groups, albuminuria developed in only three surgical patients and two medical patients (p > 0.05). CONCLUSION: Although bariatric surgery is associated with more reduction in body weight and better glycemic control than intensive medical therapy, sleeve-gastrectomy may not be superior to intensive medical care in prevention of microalbuminuria in patients with T2DM.

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