Endocrine Abstracts

Short chain fatty acids (SCFAs), including propionate, are the main metabolic by-products in the fermentation of non-digestible dietary fibre by the gut microbiota. SCFAs have wide-ranging effects in vivo, and their receptors, free fatty acid receptor 2 (FFAR2) and free fatty acid receptor 3 (FFAR3), are expressed at numerous tissue sites. Sodium propionate supplementation has been shown to increase energy expenditure, induce sympathetic neuron action potentials and p...

Background: Distress tolerance (DT) has been proposed as a possible contributor to the ability to successfully adhere to difficult behaviour changes, such as stopping problematic substance and cigarette use. A number of measures of DT have been used in attempts to predict behaviour change outcomes. Findings however, have been inconclusive and no one measure has shown consistent results. Importantly, no work has yet assessed the predictive value of DT measures in successful wei...

Effective management of obesity is increasingly challenging with the continued growth of the nation’s waistlines and bariatric surgery is not the always the answer to this problem. The synergistic action of GLP-1 agonists (GLP1A) and SGLT2 inhibitors (SGLT2I) represents a possible therapeutic approach for patients with Type 2 diabetes (T2DM) and obesity in whom bariatric surgery has been ineffective or is not possible. A single centre retrospective study was performed to ...

The specialist weight management service (SWMS) is a tier 3 service offered to patients who meet a criterion of raised BMI with or without comorbidities. It is a multi-disciplinary service made up of physician, GPwSI, dietitians, physiotherapist, psychologists and health trainers. Approximately 40% of the patient within the service has type 2 diabetes. As part of a quality improvement pilot study a diabetes specialist nurse was introduced to the team. Patients were seen in an ...

Introduction: Clinicians are hopeful for substantial weight loss after surgical intervention for obesity, with the funding decisions relatively easier to achieve in those with diabetes, there is a significant proportion of these patients undergoing procedures. In contrast to most outpatient encounters, a 20 kg drop in weight is looked upon favourably between follow-ups where it would have risen the spectre of pathology elsewhere. We present the following case that illustrates ...

Introduction: Prevalence of obesity is increasing worldwide. As a consequence the number of people undergoing bariatric surgery is also on the rise. Hypoglycaemia is increasingly seen in patients who have undergone gastric bypass surgery and we have successfully managed most of them. Here we describe our experience in dealing with one of the patients with disabling hypoglycaemia.Case-report: A 35-year-old woman with BMI of 41.87 kg/m2 had Roux...

Background: Hyperinsulinemic hypoglycaemia (HH) after Roux-en-Y gastric bypass (RYGB) is rare. Patients typically present with post-prandial hypoglycaemia >1 year after surgery and once weight loss has plateaued. Despite multiple treatment options, the management of these patients remains challenging.Clinical case: A 31-year-old female was referred for bariatric surgery with a BMI of 41.4 kg/m2. In the year preceding the r...

Mrs MP was referred to the Weight Management service in 2011, aged 45. She weighed 108 kg, with a BMI of 40 kg/m2. She had type 2 diabetes, but no other past medical history and was working in a high profile job. A Roux-en-Y bypass was performed in November 2011, with no immediate complications. She successfully lost 25% of her body weight and by April 2012 weighed 79.2 kg. Towards the end of 2015 she was re-referred with symptoms of severe fatigue, poor concentrati...

Initial presentation: A 44 year-old Caucasian patient with severe and complex obesity and type 2 diabetes was referred to hospital diabetes clinic for optimal medication advice. Her BMI on presentation was 49 kg/m2, (148 kg) and HbA1c of 7.0%. Her treatment included metfomin, sulphonylurea, rapid acting insulin (total daily doses 30 unit), and long acting insulin (total daily doses 25 unit). She also suffers complications of hypertension, dyslipidaemia, osteoarthrit...