Endocrine Abstracts

Introduction: Diabetes is a chronic condition which has become a major public health concern approaching epidemic proportions globally. Effective diabetes management often presents many challenges. Clinicians and patients often become overwhelmed by the need to address co-morbid chronic conditions in addition to patients’ diabetes-specific treatment goals. It is widely accepted that bariatric surgery can help improve health in a range of metabolic diseases, including T2DM and obesity. Bariatric surgeries promote weight loss, which can lead to improvements in hyperglycemia and dyslipidemia.

Case review: A 68year oldwas referred to the to theendocrine team with poor diabetic control, ongoing chronic kidney disease and previous history of non- alcoholic fatty liver and prostate hyperplasia, for which he was taking Metformin- (1 g BD), Forxiga- (10 mg OD), Finasteride- (5 mg OD) and Alfuzosin- (10 mg o.d.). On physical examination the patients Weightwas 131 kg, hisheart rate was – 99 bpm, and hisBlood pressure was 154/8 mmHg. There was no evidence of peripheral neuropathy or ulceration. Laboratory findings showed, Urea-8.8, Creatinine-114, eGFR > 60 and HBA1C-77 mmol/ mol

The patient was referred to a dietician to help with his weight loss and diebetic control. The patient was again seen by the endocrine team 6 months later and his weight remained alarmingly high (126 kg) despite consulting a dietician and his diabetes remained uncontrolled. Following successful gastric bypass surgery in December 2018 the patient lost 20 kg and he showed good diabetic control with glucose level of 4.5–6.0 mmol/l. his most recent HbA1c was 33 which is within normal range.

Discussion: Following, successful gastric bypass the patient glucose level returned to normal physiological level and there was gradually decline in HbA1c. Therefore, all previously prescribed anti diabetic drugs were stopped and the patient also demonstrated substantial weight loss. The use of surgical intervention for obese Type 2 diabetes patients at risk of disease progression should be considered because diabetes is the leading cause of non-traumatic lower extremity amputation and blindness in the United Kingdom. Majority of diabetes-related amputations in England are preventable if patients get the right early preventative care upon recognition of uncontrolled diabetes.

Conclusion: Bariatric surgery is robust means for treating diabetes and obesity. The use of this would limit both the over prescription of anti-diabetic therapy and lower their cost, which at the moment is estimated to cost the NHS over billion pounds.