Abstract:BACKGROUND
Observational studies have shown improvement in patients with type 2 diabetes mellitus after bariatric surgery.
METHODS
In this randomized, nonblinded, single-center trial, we evaluated the efficacy of intensive medical therapy alone versus medical therapy plus Roux-en-Y gastric bypass or sleeve gastrectomy in 150 obese patients with uncontrolled type 2 diabetes. The mean (±SD) age of the patients was 49 ± 8 years, and 66% were women. The average glycated hemoglobin level was 9.2 ± 1.5%. The prima… Show more
“…The Surgical Treatment and Medications Potentially Eradicate Diabetes Efficiently (STAMPEDE) study examined 150 T2D patients who either received intensive medical therapy alone or medical therapy in addition to a Roux-en-Y gastric bypass or sleeve gastrectomy. 18 Both surgical groups were significantly more likely to reach target HbA1c levels of 6.0% or less and reduce or eliminate diabetic medications, with lowered fasting plasma glucose and improved insulin sensitivity compared with the intensive medical therapy group. Unsurprisingly, weight loss was also greater in the surgical groups.…”
Lifestyle therapy is an integral part of type 2 diabetes (T2D) management, but there remains no consensus on an optimal diet. The objective of this study is to evaluate the efficacy of therapeutic fasting as a treatment for T2D. This case follows a male T2D patient treated at the Intensive Dietary Management Clinic in Scarborough, Ontario, over a 4-month period. The patient’s initial fasting regimen consisted of a 24-h fast, three times a week. Over the course of treatment, the patient gradually extended his fasting period, eventually fasting for 42 h, two to three times a week. By the end of treatment, the patient’s weight was reduced by 17.8% and his waist circumference was reduced by 11.0%. In addition, the patient’s glycated haemoglobin levels decreased from 7.7% to 7.2%, and he was able to completely discontinue his insulin treatment, despite over a decade of insulin usage. The patient did not find it difficult to adhere to the fasting schedule and did not experience any hypoglycaemic episodes or other significant adverse effects. These observations suggest that therapeutic fasting may be a viable treatment option for T2D patients.
“…The Surgical Treatment and Medications Potentially Eradicate Diabetes Efficiently (STAMPEDE) study examined 150 T2D patients who either received intensive medical therapy alone or medical therapy in addition to a Roux-en-Y gastric bypass or sleeve gastrectomy. 18 Both surgical groups were significantly more likely to reach target HbA1c levels of 6.0% or less and reduce or eliminate diabetic medications, with lowered fasting plasma glucose and improved insulin sensitivity compared with the intensive medical therapy group. Unsurprisingly, weight loss was also greater in the surgical groups.…”
Lifestyle therapy is an integral part of type 2 diabetes (T2D) management, but there remains no consensus on an optimal diet. The objective of this study is to evaluate the efficacy of therapeutic fasting as a treatment for T2D. This case follows a male T2D patient treated at the Intensive Dietary Management Clinic in Scarborough, Ontario, over a 4-month period. The patient’s initial fasting regimen consisted of a 24-h fast, three times a week. Over the course of treatment, the patient gradually extended his fasting period, eventually fasting for 42 h, two to three times a week. By the end of treatment, the patient’s weight was reduced by 17.8% and his waist circumference was reduced by 11.0%. In addition, the patient’s glycated haemoglobin levels decreased from 7.7% to 7.2%, and he was able to completely discontinue his insulin treatment, despite over a decade of insulin usage. The patient did not find it difficult to adhere to the fasting schedule and did not experience any hypoglycaemic episodes or other significant adverse effects. These observations suggest that therapeutic fasting may be a viable treatment option for T2D patients.
“…HbA1c was 7.5% in the medical group 6.4% in the gastric bypass group and 6.6% in the sleeve gastrectomy group. No deaths or life threatening complications occurred [26] . An editorial in the same edition by Zimmet et al [27] suggests that the bariatric surgery should not be seen as a last resort.…”
“…In the same edition of the journal Schauer et al [26] evaluated the efficacy of intensive medical therapy as compared to medical therapy plus Roux en Y gastric bypass or sleeve gastrectomy in 150 obese patients with uncontrolled type 2 diabetes. The primary end point was the proportion of patients with a glycated haemoglobin level of 6.0% or less, 12 mo after treatment.…”
“…An editorial in the Lancet where the results were published is entitled "SGLT2 inhibitors for diabetes: turning symptoms into therapy" and makes the point that the place of this class of drugs in the treatment of type diabetes is still to be decided [36] . There has been concern about breast and bladder cancer as wellIn the same edition of the journal Schauer et al [26] evaluated the efficacy of intensive medical therapy as compared to medical therapy plus Roux en Y gastric bypass or sleeve gastrectomy in 150 obese patients with uncontrolled type 2 diabetes. The primary end point was the proportion of patients with a glycated haemoglobin level of 6.0% or less, 12 mo after treatment.…”
“…Obesity is defined as a chronic disease (AMA, 2013; WHO, 2010) and a lifelong struggle with a negative impact on health and quality of life (Aguilera, 2014; Schauer et al, 2012). So far, surgical treatment has been shown to be the only long-term solution for weight loss and reducing the number of comorbid conditions (Ayman et al, 2010).…”
Weight-loss surgery requires lifelong lifestyle modifications for the maintenance of weight loss and health effects, and can affect both the individual and family. Earlier research indicates that the quality of social relationships has positive and negative influences on wellbeing and health. There is little research on family-life after a member has undergone gastric bypass (GBP) against obesity. Thus, this study aimed to develop a classic grounded theory about families with a member treated with GBP against obesity. The study design used classic grounded theory and included data from 16 interviews. Families’ shared a main concern of unexpected changes after GBP, resulting in the theory Stabilizing family life, explained as a social process to decrease uncertainty and find stability and well-being in family interactions. The social process develops differently which entail families: attaining unity, returning to old patterns, or disconnecting to find stability, depending on the discrepancy in expectations and knowledge. This is affected by the overall life situation, life-stage and relationship quality. The theory highlights unexpected change as a potential challenge for the family, as well as how they resolve this. Hence, the theory can be applied in care strategies for families. Identification of families needing support to stabilize family life after GBP requires further research.
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