Diabetes Mellitus In Obese Patients Research Articles

EXTERNAL VALIDATION OF THE DIAREM SCORE AS REMISSION PREDICTOR OF DIABETES MELLITUS TYPE 2 IN OBESE PATIENTS UNDERGOING ROUX-EN-Y GASTRIC BYPASS.

Background : DiaRem score consists in preoperative model for predicting remission of type 2 diabetes mellitus in obese patients who underwent gastric bypass. Aim : To evaluate the applicability of DiaRem comparing the scores obtained preoperatively with remission of T2DM after surgery. Method : Preoperative parameters such as age, use of insulin, oral hypoglycemic agents and glycated hemoglobin, were retrospectively evaluated in diabetic patients undergoing gastric bypass during the period between July 2012 to July 2013. Through these data the DiaRem score were applied. The results of fasting blood glucose and glycated hemoglobin were requested prospectively. Results : Were selected 70 patients; the remission of T2DM after surgery was found in 42 (60%) and no remission in 28 (40%). Checking the final score, it was observed that: from 0 to 2 points, 94.1% of patients remitted completely; between 3 and 7 had remission in 68.9%, of which 42.8% complete; from 8 to 12, 57.1% achieved complete remission; between 13 to 17, 87.5% did not achieve remission and was not seen this complete remission group; between 18 to 22, 88.9% were not remitted. Conclusion : The DiaRem score showed appropriate tool to assess remission of T2DM in obese patients who will undergo gastric bypass.

Analysis of risk factors in obese patients with coronary artery disease, with and without diabetes mellitus type two

Diabetes mellitus type 2 is one of the leading chronic diseases in the world and in our country, which is an important risk factor for development of cardiovascular morbidity and mortality. Objective. The aim of this research was making the estimation of risk factors in the etiology of coronary heart disease in obese patients with diabetes mellitus type 2. The study included 82 obese patients, of which 52 with diabetes mellitus and 30 without diabetes mellitus, in all of them coronary artery disease proven by coronary angiography. All were examined by clinical examination, laboratory tests and echocardiography. Based on the test results we found that the distribution of risk factors such as hypertension, family burden coronary artery disease, smoking, alcohol intake was the same in the obese patients with diabetes mellitus, and of those without diabetes mellitus. Echocardiography showed significantly larger left ventricle, lower ejection fraction, larger left atrium and significant mitral regurgitation. Also, in a group of patients with diabetes mellitus, there was significantly higher number of patients with multiple vessel coronary disease. Despite the small sample, we can conclude that the present of diabetes mellitus in obese patients is crucial for severe forms of coronary artery disease. Severity is expressed through significant structural and functional changes in the left ventricle and the number of diseased coronary arteries.

Association of resistin gene polymorphisms with insulin resistance in Egyptian obese patients

BackgroundObesity associated insulin resistance is a major risk factor for type 2 diabetes mellitus. Resistin is recently reported to provide a link between obesity, insulin resistance and type 2 diabetes mellitus. We aimed to investigate the possible associations of resistin gene (RETN) polymorphisms with obesity, and to detect whether these polymorphisms are associated with glucose intolerance and type 2 diabetes mellitus in obese patients. MethodsOne hundred and forty-five Egyptian obese patients with or without glucose intolerance and 155 unrelated healthy controls were enrolled in this study. Polymorphisms of RETN +299G>A and RETN –420 C>G gene were detected by polymerase chain reaction - restriction fragment length polymorphism (PCR-RFLP). Serum resistin was measured by ELISA. ResultsRETN +299 AA and RETN −420 GG genotypes were significantly associated with obesity in Egyptian population. Moreover, the mutant alleles or genotypes of both examined polymorphisms were associated with impaired glucose tolerance and diabetes mellitus compared to normal glucose tolerant obese patients. Furthermore, our results revealed elevated waist/hip ratio, BMI, blood pressure, fasting blood glucose level, HOMA-IR, triglycerides, total cholesterol, resistin level, and decreased HDL cholesterol level in homozygote mutant genotypes carriers of both RETN polymorphisms among obese patients. ConclusionResistin gene polymorphisms may play an important role in pathogenesis and susceptibility to obesity, impaired glucose tolerance, and type 2 diabetes mellitus in Egyptian population.

Predictors of remission of type 2 diabetes mellitus in obese patients after gastrointestinal surgery

Gastroenterology is a beneficial treatment of morbidly obese type 2 diabetes mellitus (T2DM). We aimed to identify the predictors for the treatment of T2DM obese patients. A retrospective study consisting of 531 patients undergoing laparoscopic gastric banding (LGB), laparoscopic mini-gastric bypass (LMGB) and laparoscopic sleeve gastrectomy (LSG) from January 2004 to May 2007 was performed. Patients with preoperative fasting serum glucose concentration of more than 126 mg/dl were diagnosed as T2DM. A postoperatively fasting serum glucose level of less than 110 mg/dl was considered to be remission of T2DM. Of the 531 patients, 62 (11.6%) were diagnosed as T2DM, including 23 men and 39 women, with a mean age of 31.8 ± 9.2 years, and a mean body mass index (BMI) of 40.0 kg/m(2). The mean glucose at 3, 6, and 12 months after surgery were 100.1 mg/dl, 95.1 mg/dl and 91.8 mg/dl, respectively. The mean body weight loss one year after surgery was 9.4% for LGB, 31.4% for LSG and 37.1% for LMGB, respectively. Among these operation methods (LGB, LMGB and LSG), the BMI, body weight, waist circumference, serum lipid profile and serum factors associated with glucose metabolism were significantly different during the one-year postoperative follow-up. Remission rate of T2DM was achieved in 84.8%, 58.8% and 58.3% of patients for LMGB, LGB and LSG, respectively. The best operative method for the remission of T2DM was LMGB. Using an artificial neural network (ANN) data mining technique, waist circumference, operative methods and C-peptide were significantly predictors for the remission of T2 DM. One year after gastrointestinal surgery, improvement of serum lipid profiles and serum data related to glucose metabolism in the different operative methods were noticed. LMGB seems to be the most effective procedure for the reduction of serum glucose levels compared with LAGB and LSG.

The Relationship Between Type 2 Diabetes Mellitus and Failure to Proton Pump Inhibitor Treatment in Gastroesophageal Reflux Disease

There is limited information regarding the contribution of diabetes mellitus (DM) to proton pump inhibitor (PPI) failure in gastroesophageal reflux disease (GERD) patients. To determine whether type 2 DM is a risk factor for PPI failure and the potential predictive factors for PPI failure among type 2 DM patients with GERD. A case-control study was performed using hospital medical records of GERD patients treated with a PPI. The prevalence of type 2 DM and other risk factors (established >1 y before study enrollment) was determined in the PPI failure (treatment with more than once daily PPI) as compared with PPI responders. A total of 732 GERD patients receiving PPI therapy, including 285 who failed PPI treatment, were included. The overall prevalence of PPI failure was significantly higher in diabetic versus nondiabetic patients. The relationship between PPI failure and type 2 DM depended on body mass index. Only in obese patients the odds ratio of PPI failure was significantly higher in type 2 DM as compared with non-DM patients. In the subgroup of GERD patients with type 2 DM (n=349), PPI failure was significantly associated with female sex, the presence of general comorbidities, and adequate DM control. Duration of DM, type of antidiabetic medication prescribed, and DM-associated complications were not associated with PPI failure. PPI failure was significantly associated with type 2 DM in obese patients. Among GERD patients with type 2 DM, failure of PPI treatment was significantly associated with female sex and the presence of general comorbidities.

Metabolic surgery – a new frontier in the treatment of diabetes mellitus

With two randomised prospective studies, ‘Bariatric surgery versus conventional medical therapy for type 2 diabetes’ by Geltrude Mingrone et al.1 and ‘Bariatric surgery versus intensive medical therapy in obese patients with diabetes’ by Philip Schauer et al.,2 published in 2012 in the New England Journal of Medicine, bariatric and metabolic surgery highlights its potential benefit in the treatment of type 2 diabetes mellitus in obese patients.

Effects of bariatric surgery on Type-2 Diabetes Mellitus in a Caribbean setting

Objectives To determine if there is a beneficial effect of bariatric surgery in the management of Diabetes Mellitus in obese patients in a Caribbean setting. Methods A retrospective review of charts of all obese patients with Type-2 Diabetes Mellitus (DM) who had undergone Laparoscopic Roux en Y gastric bypass (LRYGBP) over a 4 year period was undertaken and clinical data recorded. A questionnaire was prospectively administered via telephone to determine the quality of life. Results Of 146 patients who underwent LRYGBP, 40 were found to have clinically significant DM. Patients of age < 50 years and females had a higher preponderance of DM. Patient body weight decreased significantly from a pre-operative131.2 ± 21.6 [Mean ± Standard Deviation (SD)] to 99.4 ± 16.6 after surgery ( p < 0.0001). There was also a significant reduction of BMI from 47.0 ± 7.9 to 34.7 ± 5.8 ( p < 0.0001). There was complete resolution of clinically significant DM in 85% of patients, while in 15% there was a significant reduction in the dosage of anti-diabetic medications. Perioperative complications were minimal and there was no mortality. 96% of the patients reported a drastic improvement in their quality of life. Conclusions Bariatric surgery for obese diabetic patients resulted in complete resolution, improved diabetes control and overall improvement in the quality of life. Due to better outcomes, the surgery can safely be recommended in the Caribbean multiethnic setting where there is a high prevalence of obesity and Diabetes Mellitus.

Bariatric Surgery as a Treatment for Type 2 Diabetes Mellitus in Obese Patients

Bariatric Surgery as a Treatment for Type 2 Diabetes Mellitus in Obese Patients

Effect of sleeve gastrectomy on patients with diabetes mellitus

Background Limited data are available evaluating the effect of sleeve gastrectomy on the control of DM. Our objective was to evaluate the effectiveness of sleeve gastrectomy in improving glycemic control of obese patients with diabetes mellitus (DM) at a research clinic. Methods A retrospective review of a prospectively maintained database collected between January 2005 and January 2007 was conducted. A total of 30 patients with DM who had undergone laparoscopic sleeve gastrectomy were studied. At the 2- and 6-month follow-up visits, we analyzed the variation in glycosylated hemoglobin, fasting blood glucose, and body mass index. Results Of the 30 patients with ≥6 months postoperative follow-up, 22 (73%) had been taking medications for type 2 DM preoperatively. Resolution of DM was observed in 27% at 2 months and 63% at 6 months of follow-up. Glycosylated hemoglobin decreased from 6.36 ± .82 (n = 14) preoperatively to 6.02 ± .57 (n = 11) at 2 months and 5.92 ± .33, (n = 12) at 6 months after surgery. The body mass index decreased from 46.12 ± 10.86 (n = 30) preoperatively to 38.27 ± 6.59 (n = 30) at 2 months and 35.78 ± 5.11 (n = 29) at 6 months after surgery. Patients with a shorter duration of DM (<5 yr) and better weight loss after surgery achieved greater resolution rates. Conclusion The improvement and resolution of DM in obese patients has been observed as a result of weight loss after sleeve gastrectomy.

Obesity in a chronic hemodialysis population

Objective: To estimate the prevalence of obesity in the chronic hemodialysis (CHD) population and determine the effect of obesity on the morbidity and mortality in these patients. Design: Retrospective survey with some prospective elements. Setting: Four free-standing outpatient dialysis units. Patients: Of 296 CHD patients screened, 60 obese CHD patients (≥120% ideal body weight and body mass index ≥28) were identified, including 34 males and 26 females of ages 44 to 84 years. The control group included 60 nonobese CHD patients (90% to 110% ideal body weight and body mass index >19 and <28), including 34 males and 26 females ages 43 to 83 years. Interventions: A noninterventional study; routinely collected demographic, anthropometric, bioelectrical impedance analysis, biochemical, urea kinetic, and clinical data were analyzed. Main outcome measures: Comparison of the existence of comorbidities, hospitalization, and mortality in obese and nonobese CHD patients. Results: Obesity is prevalent in 20% of the CHD population. In obese versus nonobese patients, there was an increased incidence of diabetes mellitus in obese patients (48% v 30%), a higher percentage of patients at increased risk of developing coronary heart disease as determined by lipid profiles (52.9% v 36.7%), an increased hospitalization rate (mean annualized hospital days, 35.52 v 17.6 days per year), and increased death rate (5 v 3 incidents), respectively. Conclusion: Increased morbidity and mortality was observed in the obese CHD patients. Further study is warranted to determine the impact of diet, exercise, and physical training on morbidity and mortality in this group of patients.