Background: Lipedema is a loose connective tissue disease affecting the limbs of women, that is difficult to lose by diet, exercise, or bariatric surgery. Publications from Europe demonstrate that lipedema reduction surgery improves quality of life for women with lipedema. There are no comparable studies in the United States (USA). The aim of this study was to collect data from women with lipedema in the USA who have undergone lipedema reduction surgery in the USA to determine if quality of life, pain, and other measures improved after lipedema reduction surgery. Methods: Subjects were recruited and consented online for a 166-item questionnaire in REDCap. In total, 148 women answered the questionnaire after undergoing lipedema reduction surgery in the USA. Significance set at P < 0.05 was determined by ANOVA, Tukey’s multiple comparison test, or paired t -test. Results: Quality of life improved in 84% and pain improved in 86% of patients. Ambulation improved most in lipedema Stage 3 (96%). Weight loss occurred in all stages by 3 months after surgery. Complications included growth of loose connective tissue within and outside treated areas, tissue fibrosis, anemia, blood clots, and lymphedema. Conclusions: Women with lipedema noticed significant benefits after lipedema reduction surgery in the USA. Prospective studies are needed to assess benefits and complications after lipedema reduction surgery in the USA.

Madelung's disease, also known as benign symmetric lipomatosis or Launois-Bensaude syndrome was first described by Sir Benjamin Brodie in 1846 from a series of patients he had encountered characterizing adipose tumors deposited preferentially on the neck [1]. It is a disorder of fat metabolism with deposition of multiple, symmetrical and painless non-encapsulated lipomas. Depending on the type of Madelung's Disease, the adipose tissue deposition can be seen in the neck, upper extremities, trunk and hip area. About 90% of the cases described in the literature have been associated with chronic alcoholism and tobacco use and in a population of European/ Mediterranean descent, reporting up to 1 in 25,000 cases in Italy to have the condition [2,3]. Rare cases have also been reported in Indians and one case in an African American male [4,5]. We present a case of a 48-year-old Hispanic male of Mexican ancestry with no significant history of alcoholism who presented to our emergency department with chief complaint of progressive proximal muscle weakness in upper and lower extremities resulting in an inability to walk or care for daily activities.

Background: The achievement of the A1C goals in the US did not improve in 2017 compared to 2014. Guidelines for which patients with T2DM to refer to an endocrinologist are not well defined. Furthermore, there is no consensus about how long patients should be followed by an endocrinologist. Experts have recommended referral to an endocrinologist for new diagnosis, acute hyperglycemia, A1C &gt; 7.0, &gt; 8.0 for 6 months, or A1C 1.4 times the upper limit of normal. However, with the current number of board-certified endocrinologists in the US, it would be impossible for patients with those criteria to be seen even once. To determine which patients should be followed by an endocrinologist, it would help to know which patients are most likely to achieve ongoing benefit. To focus on patients that have a higher chance of improvement, it is important to know the average time it would take to reach an individualized A1C goal and focus on patients more likely to improve. Objective: We performed this quality improvement assessment to 1) determine the percentage of patients with T2DM who achieved their individualized A1C goals (Age 18–55: 7.0% +/- .5%, 55–75: 7.5% +/- .5%, &gt;75: 9.0% +/- .5%) at 12 months after their initial endocrinologist visit and 2) compare characteristics of patients who achieved A1C goals by 12 months versus those who did not achieve goals. Material and Methods: We performed a retrospective chart review of patients with T2DM who had an initial visit at an academic endocrinology clinic between 10/1/2017 and 05/31/2018 (N= 48, 52% female, baseline 9.6%, 48% male, baseline [BL] HbA1c 9.9%). Data for 12 months following the initial visit were collected. Results: Following their initial visit, 21/48 (44%, BL A1c 10.3%) were lost to follow-up. Of those with at least one additional visit, 12/27 (44%, BL A1c 11.3%, P&lt;0.05) achieved A1C goal by the 12-month period. Of those, 6/12 (50%, BL A1c 10.3%), 1/12 (8%, BL A1c 9.9%), 4/12 (25%, BL A1c 9.0%), 1/12 (8%, BL A1c 8.8%) achieved goals by 3, 6, 9, and 12 months respectively. Those who did achieve their goals were slightly older (52 +/- 25yrs) than those who did not (50 +/- 12yrs), p&lt; 0.05. No significant differences between those who were lost to follow-up, achieved goals, or who did not achieve goals with respect to gender, insurance coverage, or regimen. However, those who did continued care had a worse A1c of 11.3%. Conclusion: Of patients with T2DM and uncontrolled hyperglycemia presenting to an academic endocrine clinic, nearly half are lost to follow-up after the initial visit. Future efforts should be made to better understand and potentially improve this. Of additional concern, only about half of patients with at least one additional visit achieved their A1C goal after 12 months, and 91% of those achieved their goals by 9 months. Further study will be needed to determine whether patients who are uncontrolled after 9–12 months will have any further benefit from endocrine follow-up.