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Glycemic control operation

Norbert Runkel, Rainer Brydniak
BACKGROUND: Bariatric surgery is gastrointestinal surgery for weight control, and metabolic surgery refers to the use of surgery to primarily and purposely treat type 2 diabetes mellitus (T2DM)/metabolic syndrome mellitus. METHODS: The most recent literature was reviewed for surgery and T2DM in a non-systematic fashion. RESULTS: Roux-Y gastric bypass, biliopancreatic diversion with duodenal switch, and sleeve gastrectomy (SG) are the dominant procedures today...
October 2016: Visceral Medicine
Lindsay M Arnold, Mufaddal Mahesri, Marie E McDonnell, Sara M Alexanian
OBJECTIVE: While hyperglycemia in the postoperative setting has been linked to an increase in surgical complications, limited data is available to inform the management of patients with diabetes (DM) in the operating room and the immediate perioperative period. We describe the results of a perioperative glycemic control program that standardized intravenous insulin with a target glucose (BG) range of 120-180 mg/dL for patients with DM presenting with a BG level > 180mg/dL and included transition to subcutaneous insulin...
November 7, 2016: Endocrine Practice
Stella P Kim, Josiane L Broussard, Cathryn M Kolka
INTRODUCTION: Anesthesia induces insulin resistance, which may contribute to elevated blood glucose and adverse post-operative outcomes in critically ill patients, and impair glycemic control in surgical patients with diabetes. However, little is known about the mechanisms by which anesthesia impairs insulin sensitivity. Here we investigate the effects of anesthesia on insulin sensitivity in metabolic tissues. METHODS: Hyperinsulinemic-euglycemic clamps were performed in 32 lean (control diet; n = 16 conscious versus n = 16 anesthetized) and 24 fat-fed (6 weeks fat-feeding; n = 16 conscious versus n = 8 anesthetized) adult male mongrel dogs in conjunction with tracer methodology to differentiate hepatic versus peripheral insulin sensitivity...
2016: PloS One
Hao Liu, Yun Hu, Feng-Fei Li, Bing-Li Liu, Xiao-Fei Su, Jian-Hua Ma
BACKGROUND: Dipeptidyl peptidase-4 (DPP-4) inhibitors are widely used as second-option medications when metformin fails. Variance of the glycated hemoglobin (HbA1c) response to DPP-4 inhibitions in patients with type 2 diabetes mellitus (T2DM) has been observed, but the characteristics which predict the response to DPP-4 inhibitor therapy are unclear. The aim of this study was to investigate the characteristics of α- and β-cell functions which might predict the efficacy of saxagliptin and facilitate personalization of treatment...
December 2016: Diabetes Therapy: Research, Treatment and Education of Diabetes and related Disorders
Charles E Edmiston, David J Leaper
BACKGROUND: Intra-operative surgical site irrigation (lavage) is common practice in surgical procedures in general, with all disciplines advocating some form of irrigation before incision closure. This practice, however, has been neither standardized nor is there compelling evidence that it effectively reduces the risk of surgical site infection (SSI). This narrative review addresses the laboratory and clinical evidence that is available to support the practice of irrigation of the abdominal cavity and superficial/deep incisional tissues, using specific irrigation solutions at the end of an operative procedure to reduce the microbial burden at wound closure...
September 27, 2016: Surgical Infections
Karl J Neff, Jessie A Elliott, Caroline Corteville, Kathrin Abegg, Camilo Boza, Thomas A Lutz, Neil G Docherty, Carel W le Roux
BACKGROUND: Reductions in urinary protein excretion after Roux-en-Y gastric bypass (RYGB) surgery in patients with diabetic kidney disease have been reported in multiple studies. OBJECTIVES: To determine the weight loss dependence of the effect of RYGB on urinary protein excretion by comparing renal outcomes in Zucker diabetic fatty rats undergoing either gastric bypass surgery or a sham operation with or without weight matching. SETTING: University laboratories...
August 18, 2016: Surgery for Obesity and related Diseases: Official Journal of the American Society for Bariatric Surgery
Kyoung-Tae Kim, Dae-Chul Cho, Joo-Kyung Sung, Chi Heon Kim, Hyun Kang, Du Hwan Kim
BACKGROUND CONTEXT: Lumbar spinal stenosis (LSS) can hinder a patient's physical activity, which in turn can impair glucose tolerance and body weight regulation in patients with type 2 diabetes mellitus (DM-2). Therefore, successful lumbar surgery could facilitate glycemic control and body weight regulation. PURPOSE: This study aimed to evaluate the effects of postoperative improvement in physical activity on body mass index (BMI) and hemoglobin A1c (HbA1c) level in patients with LSS and DM-2 over a 2-year follow-up period...
September 6, 2016: Spine Journal: Official Journal of the North American Spine Society
Alper Celik, Sjaak Pouwels, Fatih Can Karaca, Eylem Çağıltay, Surendra Ugale, İlker Etikan, Deniz Büyükbozkırlı, Yunus Emre Kılıç
BACKGROUND: Medical treatment fails to provide adequate control for many obese patients with type 2 diabetes mellitus (T2DM). A comparative observational study of bariatric procedures was performed to investigate the time at which patients achieve glycemic control within the first 30 postoperative days following sleeve gastrectomy (SG), mini-gastric bypass (MGB), and diverted sleeve gastrectomy with ileal transposition (DSIT). METHODS: Included patients had a body mass index (BMI) ≥30 kg/m(2); T2DM for ≥3 years, HbA1C > 7 % for ≥3 months, and no significant weight change (>3 %) within the prior 3 months...
August 26, 2016: Obesity Surgery
Thomas Bächler, Carel W le Roux, Marco Bueter
Bariatric surgery is currently the most effective option for the treatment of morbid obesity and its associated comorbidities. Recent clinical and experimental findings have challenged the role of mechanical restriction and caloric malabsorption as the main mechanisms for weight loss and health benefits. Instead, other mechanisms including increased levels of satiety gut hormones, altered gut microbiota, changes in bile acid metabolism, and/or energy expenditure have been proposed as explanations for benefits of bariatric surgery...
2016: Clinical and Experimental Gastroenterology
Armand Valsesia, Wim Hm Saris, Arne Astrup, Jörg Hager, Mojgan Masoodi
BACKGROUND: An aim of weight loss is to reduce the risk of type 2 diabetes (T2D) in obese subjects. However, the relation with long-term glycemic improvement remains unknown. OBJECTIVE: We evaluated the changes in lipid composition during weight loss and their association with long-term glycemic improvement. DESIGN: We investigated the plasma lipidome of 383 obese, nondiabetic patients within a randomized, controlled dietary intervention in 8 European countries at baseline, after an 8-wk low-caloric diet (LCD) (800-1000 kcal/d), and after 6 mo of weight maintenance...
September 2016: American Journal of Clinical Nutrition
Ji Hoon Ahn, Seung Il Jung, Sang Un Yim, Sun Woo Kim, Eu Chang Hwang, Dong Deuk Kwon
The purpose of the present study was to determine the potential relationships of glycemic control and use of metformin with non-muscle invasive bladder cancer characteristics. We reviewed data from 645 patients with non-muscle invasive bladder cancer between January 2004 and May 2015. We analyzed the association of pre and post-operative glycemic control and use of metformin with clinical characteristics of bladder tumors. We also analyzed the association of glycemic control and use of metformin with recurrence-free and progression-free survivals...
September 2016: Journal of Korean Medical Science
Petra Kaválková, Miloš Mráz, Pavel Trachta, Jana Kloučková, Anna Cinkajzlová, Zdeňka Lacinová, Denisa Haluzíková, Marek Beneš, Zuzana Vlasáková, Václav Burda, Daniel Novák, Tomáš Petr, Libor Vítek, Terezie Pelikánová, Martin Haluzík
Duodenal-jejunal bypass liner (DJBL) is an endoscopically implantable device designed to noninvasively mimic the effects of gastrointestinal bypass operations by excluding the duodenum and proximal jejunum from the contact with ingested food. The aim of our study was to assess the influence of DJBL on anthropometric parameters, glucose regulation, metabolic and hormonal profile in obese patients with type 2 diabetes mellitus (T2DM) and to characterize both the magnitude and the possible mechanisms of its effect...
October 2016: Journal of Endocrinology
Francesco Giannini, Azeem Latib, Richard J Jabbour, Neil Ruparelia, Andrea Aurelio, Marco B Ancona, Filippo Figini, Antonio Mangieri, Damiano Regazzoli, Akihito Tanaka, Claudio Montalto, Lorenzo Azzalini, Fabrizio Monaco, Eustachio Agricola, Alaide Chieffo, Matteo Montorfano, Ottavio Alfieri, Antonio Colombo
BACKGROUND: Post-operative hyperglycemia, in individuals with and without diabetes, has been identified as a predictor of acute kidney injury (AKI) in patients following cardiac surgery. Whether or not this is also true for patients undergoing transcatheter aortic valve implantation (TAVI) is unknown. OBJECTIVES: To evaluate whether post-procedural glucose levels are associated with AKI after TAVI. METHODS AND RESULTS: A total of 422 consecutive patients undergoing transfemoral TAVI were included in the analysis...
October 15, 2016: International Journal of Cardiology
Ali Aminian, Stacy A Brethauer, Amin Andalib, Suriya Punchai, Jennifer Mackey, John Rodriguez, Tomasz Rogula, Matthew Kroh, Philip R Schauer
OBJECTIVE: The aim of the study was to assess long-term metabolic effects of laparoscopic sleeve gastrectomy (LSG) in patients with type 2 diabetes (T2DM) and to identify predictive factors for long-term diabetes remission and relapse. BACKGROUND: LSG has become the most common bariatric operation worldwide. Its long-term metabolic effects in patients with T2DM are, however, unknown. METHODS: Outcomes of 134 patients with obesity with T2DM who underwent LSG at an academic center during 2005 to 2010 and had at least 5 years of follow-up were assessed...
October 2016: Annals of Surgery
Thiago I B Lopes, Bruno Geloneze, José C Pareja, Antônio R Calixto, Márcia M C Ferreira, Anita J Marsaioli
Roux-en-Y gastric bypass (RYGB) surgery goes beyond weight loss to induce early beneficial hormonal changes that favor glycemic control. In this prospective study, ten obese subjects diagnosed with type 2 diabetes underwent bariatric surgery. Mixed-meal tolerance test was performed before and 12 months after RYGB, and the outcomes were investigated by a time-resolved hydrogen nuclear magnetic resonance ((1)H NMR)-based metabolomics. To the best of our knowledge, no previous omics-driven study has used time-resolved (1)H NMR-based metabolomics to investigate bariatric surgery outcomes...
July 2016: Omics: a Journal of Integrative Biology
Z D Zang, Z Yan, J J Hui, J Yan, H Y Chen
OBJECTIVE: To retrospectively analyze the prognostic significance of mean amplitude of glycemic excursion (MAGE) in patients with severe burn. METHODS: A study involving 76 patients with severe burn admitted into Department of Burns of the Third People's Hospital of Wuxi City from January 2011 to August 2014, conforming to the inclusion criteria was conducted. Data of their demography, injury, and treatment were collected. Blood glucose level of patients was measured during the first 72 h after admission, and MAGE was calculated...
January 2016: Zhonghua Shao Shang za Zhi, Zhonghua Shaoshang Zazhi, Chinese Journal of Burns
Nazish Saleem, Brian Godman, Shahzad Hussain
BACKGROUND: Gestational diabetes mellitus is a common medical problem associated with maternal and fetal complications. Good glycemic control is the cornerstone of treatment. OBJECTIVE: Compare outcomes between four times (q.i.d) and twice daily (b.i.d) regimens. The morning dose of the b.i.d regimen contained two-thirds of the total insulin, comprising a third human regular insulin and two-thirds human intermediate insulin; equal amounts in the evening. METHODS: 480 women at >30 weeks with gestational diabetes mellitus with failure to control blood glucose were randomly assigned to either regimen...
August 2016: Journal of Comparative Effectiveness Research
Patrizia Ferroni, Silvia Riondino, Anastasia Laudisi, Ilaria Portarena, Vincenzo Formica, Jhessica Alessandroni, Roberta D'Alessandro, Augusto Orlandi, Leopoldo Costarelli, Francesco Cavaliere, Fiorella Guadagni, Mario Roselli
BACKGROUND: Based on the hypothesis that impaired glucose metabolism might be associated with survival outcomes independently of overt diabetes, we sought to investigate the prognostic value of routinely used glycemic parameters in a prospective study of breast cancer (BC) patients. PATIENTS AND METHODS: Fasting blood glucose, insulin and HbA1c levels, and insulin resistance (assessed by the Homeostasis Model Assessment [HOMA] index) at diagnosis were evaluated in 286 nondiabetic BC patients (249 with primary cancer, 37 with metastatic) with respect to those parameters' possible associations with clinicopathological features and survival outcomes...
September 2016: Oncologist
Badurudeen Mahmood Buhary, Ohoud Almohareb, Naji Aljohani, Saad H Alzahrani, Samer Elkaissi, Suphia Sherbeeni, Abdulrahman Almaghamsi, Mussa Almalki
CONTEXT: Diabetes in pregnancy (DIP) is either pregestational or gestational. AIMS: To determine the relationship between glycemic control and pregnancy outcomes in a cohort of DIP patients. SETTINGS AND DESIGN: In this 12-month retrospective study, a total of 325 Saudi women with DIP who attended the outpatient clinics at a tertiary center Riyadh, Saudi Arabia, were included. SUBJECTS AND METHODS: The patients were divided into two groups, those with glycated hemoglobin (HbA1c) ≤6...
July 2016: Indian Journal of Endocrinology and Metabolism
Joanna Świrska, Piotr Czuczwar, Agnieszka Zwolak, Beata Matyjaszek-Matuszek
OBJECTIVES: The aim of the study was to estimate whether diabetes was an independent risk factor for perioperative complications in patients undergoing gynecologic surgery. MATERIAL AND METHODS: The study population consisted of 182 women (diabetics and controls) who underwent elective gynecologic surgery. Each patient without diabetes from the control group and matched for age and body mass index diabetic patient were admitted with the same gynecologic diagnosis, underwent the same gynecologic procedure, were operated on in the same operating room and were hospitalized within the same time interval...
2016: Ginekologia Polska
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