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: drr@clos.net

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.”