Patient C Caucasian male, 41 years old was admitted to the inpatient department of endocrinology with newly diagnosed T2 DM, morbid obesity on the 03.03.2011.
Anamnesis: Overweight since childhood, but in the past few years he started to gain weight rapidly (because of smoking cessation). Arterial hypertension since 2003, with maximum increase up to 210/125 and he took antihypertensive drugs regularly. In 2006 painless myocardial ischemia was first diagnosed. He had a history of impaired glucose tolerance since 2009, and was administered diet with metformin 1700 mg/daily, but he soon stopped taking the drug. In 2009 he was endoscopically installed gastric band. His weight decreased up to 30 kilos in 5 month, but not for long. His parents had a history of T2DM.
Objective: Height 182 cm, Weight 190 kl, BMI 57 kl/m2. No signs of Cussing disease. BP 150/90 mm Hg, pulse rate 80 per min. Medical examination revealed: thyroid hormones, prolactin and cortisol levels were normal, but there was a significant increase in C-peptide 2.55 nmol/l (0.371.47). A1C8.5%. Glucose levels (04/03/11) 10.3 13.6 10.4 9.7 8.9 7.7 mmol/l. He was administered metformin 2550 mg/daily and a hypocaloric diet. After his blood sugar became normal (5.2 7.0 mmol/l) he was transferred to the Department of Surgery and 30.03.11 he was performed bilio pancreatic bypass in modification of HessMarceau. Postoperative period was well. He was recommended calcium supplements, iron and multivitamin complex.
Follow up 09.2011 Weight 141 kl. No complains.
12.2011 Weight 129 kl, BMI 42.59 kl/m2, A1C 5.6%, BP 120/80 mm Hg.
Surgery is a method of choice in treatment of obesity when diet and drugs are no longer effective. It improves quality of life, glycemic control and metabolic disorders and gives patient hope for a better future.
Declaration of interest: The authors declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research project.
Funding: This research did not receive any specific grant from any funding agency in the public, commercial or not-for-profit sector.
05 - 09 May 2012
European Society of Endocrinology