apc a-00120-time 2 self-ident not-diabetic
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a-00120
Dr. Robert RUTLEDGETitle of Paper: TIME TO SELF-IDENTIFICATION AS “NOT-
DIABETIC” AFTER RESOLUTION OF DIABETES FOLLOWING MINI-GASTRIC BYPASS
Nationality: United States of AmericaPosition: Director
Department: SurgeryOrganization: Center For Laparoscopic Obesity Surgery
Tel: +1-702 714 0011E-mail: [email protected]
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TIME TO SELF-IDENTIFICATION AS “NOT-DIABETIC”
AFTER RESOLUTION OF DIABETES FOLLOWING
MINI-GASTRIC BYPASS
Robert RUTLEDGE11Director, Surgery, Center For Laparoscopic Obesity Surgery, United States of America
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hys-ter-e-sis:
• n [NL, fr. Gk hysteresis shortcoming, fr. hysterein to be late, fall short, fr. hysteros later]
• a retardation of the effect when the forces acting upon a body are changed (as if from viscosity or internal friction);
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Introduction
• Evidence of the positive effects of Mini-Gastric Bypass on patients with diabetes has continued to increase.
• Recently a controlled trial showed that while the MGB **90%++ effective** resolving diabetes Sleeve was only **40% effective** (Lee et.al.)
• In addition a recent study by Sultan et al showed that in patients treated with the adjustable **Band** diabetes resolved in only 39.7%
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Introduction
• A variety of questions related to the resolution of diabetes following surgery
• Is the patient “cured” (Many recur after RNY)
• Is the patient still a diabetic if their glucose is normal and they are off medications?
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Introduction
• Normalization of blood glucose and discontinuation of diabetic medications may not lead patients to change their feelings about being labeled as a Diabetic.
• Many believe that even when they are taking no medications and have normal blood sugar they are and will always be “Diabetic.”
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Introduction
• Diabetes is usually described as a ‘lifelong (chronic) disease.’ Diabetics may continue to identify themselves as “Diabetic” even after they have discontinued all diabetic medications with normal blood sugars.
• The purpose of this study was to analyze the hysteresis between resolution of diabetes as measured by medications for diabetes and self identification as a “Diabetic.”
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Methods:
• Over the past 15 years 6,385 patient have undergone Mini-Gastric Bypass 23.6% of patients were diabetic. Follow up of patients occurs yearly after the first year.
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Methods
• Paid particular attention to two factors
• On medications for diabetes?
• Question:
• “Are you now Diabetic after surgery?”
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Results
• Resolution of diabetes as measured by discontinuation of all anti-diabetic medications was
• 90%, 95%, 94%, 95%, 94% at years 1-5.
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Results
• When asked • “Are you now a diabetic AFTER
surgery?” • only 76% identified themselves as not a
diabetic at one year, • even though 90% were off all
medications • Difference of 24%
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Results
• At 2 years • 82% identified themselves as • “Not a diabetic” • while 95% were off all medications a
difference of 13%. • The difference declined to 1.5% in year
three and 1.0% in years 4 and 5.
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Results
• Glycosylated Hemoglobin
• Preop Hgb A1c• 7.9 + 3.1
• Post Op Hgb A1c• 5.3 + 2.3
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Conclusions:
• 1. Over a 5 year follow up period diabetes resolution was rapid, highly effective and durable after Mini-Gastric Bypass.
• 2. Self identification as a “Non-Diabetic” is delayed in many patients.
• It can take up to 3 years of being free from diabetic medications until patients identify themselves as “Non-Diabetic.”