Roux-en-Y gastric bypass as a cure of iatrogenic – steroid induced diabetes
Journal Title: Polish Journal of Surgery - Year 2019, Vol 91, Issue 5
Abstract
Background Steroid induced diabetes (SIDM) is a frequently found clinical condition since steroid-based therapies continue to be widely used in hospital and ambulatory care. Recommended optimal treatment of SIDM includes similar glucose lowering strategies as in type 2 diabetes. This typical management cannot cure the disease, it can only control blood glucose. Recently, bariatric surgery has emerged as an effective treatment for type 2 diabetes mellitus. However, up to now, the usefulness of bariatric surgery in treatment of SIDM has not been evaluated. Case report 49-year-old female oncologic patient with steroid induced diabetes was referred for the surgical treatment to the Department of General and Transplant Surgery in November 2009 year. Six years earlier, she underwent successful oncologic treatment with cladribine and high doses of steroids due to hairy cell leukemia. Finally complete hematologic remission with normalization of morphology and reduction of spleen size has been obtained. Prior to the steroid treatment blood glucose and urine examinations were within normal range. Patient was non-obese and had no family history of diabetes. Nevertheless, patient developed diabetes secondary to corticosteroids therapy, poorly con-trolled by oral hypoglycemic agent (acarbosum), successfully converted to insulin therapy. On ad-mission to the Department of General and Transplant Surgery she was treated with 58 units of insu-lin per day. The patient was scheduled for Roux-en-Y gastric bypass (RYGB). Insulin was with-drawn immediately after the operation and within six months after the surgery plasma glucose and glycated hemoglobin (HbA1c-5.5%) levels reached and remained within normal range. Currently, eight years after surgery, body weight and BMI are 80 kg and 27.68 kg/m2, respectively. Plasma plasma glucose and glycated hemoglobin are also normal. Importantly, from oncological point of view, the patient has remained in continuous complete remission since October 2003. Conclusions Our report is the first to our knowledge describing the effect of gastric bypass surgery on SIDM in patient with prior hematologic malignancy. It proves that surgically altered anatomy of small intestine improves glucose homeostasis previously disturbed with pro-diabetic medication. <br/><br/>
Authors and Affiliations
Grazyna Poznanska, Piotr Hogendorf, Leszek Czupryniak, Oliwia Grząsiak, Aneta Szmiel, Anna Kasiarz, Janusz Strzelczyk, Adam Durczyński
Keywords
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- DOI 10.5604/01.3001.0012.8271
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