Longitudinal Evaluation of Glucose Profile and Obesity Using Continuous Glucose Monitoring, Bioelectrical Impedance Analysis, and Computed Tomography Fat Scan in a Patient Who Achieved Diabetes Remission After Laparoscopic Sleeve Gastrectomy Duodenojejunal Bypass.

内容摘要

Laparoscopic sleeve gastrectomy/duodenojejunal bypass (LSG/DJB) aids weight loss and improves type 2 diabetes mellitus (T2DM) in patients with obesity. Herein, we present a 1-year longitudinal evaluation using continuous glucose monitoring (CGM), bioelectrical impedance analysis (BIA), and computed tomography (CT) fat scans after LSG/DJB in a patient with obesity and T2DM. Our patient was a 33-year-old female with obesity and T2DM who had been treated with intensive insulin therapy (50 units/d) before LSG/DJB. Preoperatively, the patient had uncontrolled diabetes, with a fasting blood glucose level of 252 mg/dL and HbA1c of 10.0%. Moreover, the CGM showed 1%, 99%, and 0% time-in range (TIR), time-above range, and time-below range, respectively. LSG/DJB significantly increased the 3-, 6-, and 12-month TIR to 96%, 93%, and 89%, respectively, and decreased the time-above range to 4%, 7%, and 11%, respectively, indicating high-dose insulin withdrawal and complete diabetes remission. Twelve months post-LSG/DJB, effective abdominal fat mass loss was observed on CT. Furthermore, both FM and the percentage of fat mass were reduced, and muscle mass was maintained according to the BIA. Effective weight loss, abdominal FM loss, and complete diabetes remission were observed after LSG/DJB, according to BIA and CT. The significant increase in TIR suggests that this therapeutic approach may improve the prognosis of patients with T2DM and obesity. CGM, BIA, and CT fat scans are highly useful for the long-term management of obesity and diabetes after LSG/DJB surgery.