Year: 2025
Type: article
Abstract: Disclosure: P. Pile: None. M. Khalifa: None. H. Aftab: None. Introduction: Type 2 diabetes mellitus (T2DM) and obesity are closely linked, with obesity playing a key role in the development of insulin resistance and acting as a major risk factor for the progression of T2DM. Bariatric surgery, commonly used to treat obesity, has also demonstrated significant benefits in managing T2DM. We present a case of an adult female with obesity and T2DM who, despite high insulin requirements, experienced a significant and immediate reduction in insulin needs following bariatric surgery. Case Presentation: Patient is a 57-year-old female with history of class III obesity (BMI 42.26 kg/m2), T2DM, peripheral neuropathy and asthma. Conservative management such as dietary measures and medications for weight loss were unsuccessful. Hence, she was referred to bariatric surgery for elective sleeve gastrectomy. Prior to surgery, her diabetes regimen includes Humulin R U-500 (regular insulin) 135 units daily in the morning and tirzepatide 5 mg weekly. Her hemoglobin A1c (HbA1c) a month prior to surgery was 7.8%. She tolerated the procedure well with no major complications. On the day after the procedure, her blood glucose (BG) ranged from 120-160 mg/dL, and she was placed on a low dose lispro correctional sliding scale. She only received a total of one unit of insulin lispro before discharge and remained on this sliding scale regimen thereafter. On follow-up outpatient five months after procedure, she has lost a total of 50 pounds and her HBA1c improved to 7%. She continued to require minimal to no insulin and remained on the low dose lispro correctional sliding scale. Discussion: This case highlights how bariatric surgery not only led to significant weight loss but also improved insulin sensitivity, resulting in a dramatic reduction in the patient’s insulin needs. The improvement in insulin sensitivity is largely due to increased secretion of incretin hormones like glucagon-like peptide-1 (GLP-1) and glucose-dependent insulinotropic polypeptide (GIP). Additionally, post-procedure earlier satiety occurs, which is linked to reduced ghrelin levels and increased peptide YY (PYY) and GLP-1 levels. Obesity is a chronic inflammatory state and is often linked to lower levels of adiponectin, an anti-inflammatory cytokine. After surgery, as visceral fat decreases, adiponectin levels rise, appears to be predictive of improved insulin resistance. Conclusion: This case exemplifies the potential benefits of bariatric surgery in improving glycemic control and suggests that such procedures may offer long-term improvements in diabetes management. It also highlights the significant reduction in medication burden, as patients no longer need to perform multiple daily insulin injections, leading to greater convenience and less stress in their daily routines – ultimately improving their quality of life. Presentation: Saturday, July 12, 2025
Source: Journal of the Endocrine Society
Institutions: University of Connecticut, UConn Health
Language: English
Subfield: Surgery
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $3,255
OpenAlex ID: W7093300483
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