a-00120 Dr. Robert RUTLEDGE Title of Paper: TIME TO SELF-IDENTIFICATION AS “NOT-DIABETIC” AFTER RESOLUTION OF DIABETES FOLLOWING MINI-GASTRIC BYPASS Nationality: United States of America Position: Director Department: Surgery Organization: Center For Laparoscopic Obesity Surgery Tel: +1-702 714 0011 E-mail: firstname.lastname@example.org
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
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);
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%
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?
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.”
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.”
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.
Methods• Paid particular attention to two factors• On medications for diabetes?• Question:• “Are you now Diabetic after surgery?”
Results• Resolution of diabetes as measured by discontinuation of all anti-diabetic medications was• 90%, 95%, 94%, 95%, 94% at years 1-5.
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%
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.
Results• Glycosylated Hemoglobin• Preop Hgb A1c• 7.9 + 3.1• Post Op Hgb A1c• 5.3 + 2.3
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.”