Diabetes Remission After Radical Nephrectomy in a Geriatric Patient With Obesity and Type 2 Diabetes-34 Months' Follow-Up.

Abstract

Diabetes mellitus significantly affects survival in patients with renal cell carcinoma undergoing nephrectomy, requiring personalized care. This case involved a 64-year-old man with type 2 diabetes (T2D) who underwent radical nephrectomy for renal cell carcinoma. He consented to a 1-year intensive lifestyle intervention (ILI), including a vegan diet (to lower calorie intake, reduce uric acid, support renal health, and promote weight loss), intermittent fasting, regular exercise, psychological support, and medical management. Quarterly biochemical assessments and monthly adherence evaluations were conducted. Post intervention, the patient achieved diabetes remission, maintaining glycated hemoglobin A1c (HbA1c) below 6.5% (48 mmol/mol) (reference range, <6.5%; <48 mmol/mol) without medication. He lost 36 kg (79.37 lb), reducing his body mass index from 35.3 to 25.1. His lipid profile normalized (total cholesterol, 175 to 127 mg/dL (4.53 to 3.29 mmol/L) (reference range, <200 mg/dL; <5.18 mmol/L); triglycerides, 155 to 73 mg/dL (1.75 to 0.82 mmol/L) (reference range, <150 mg/dL; <1.69 mmol/L), allowing the discontinuation of statins. Improvements in serum creatinine and high-sensitivity C-reactive protein levels were also observed. The patient exhibited normal glucose tolerance, consecutively passing an oral glucose tolerance test for 2 years. This case highlights the potential of lifestyle modifications in managing T2D in patients with a history of nephrectomy.