Utilising a milk-based meal replacement programme in a bariatric patient with poorly controlled type 2 diabetes mellitus
A 45-year-old man with poorly controlled type 2 diabetes (T2DM) (HbA1c 87 mmol/mol) despite 100 units of insulin per day and severe obesity (BMI 40.2 kg/m2) was referred for bariatric intervention. He declined bariatric surgery or GLP1 agonist therapy. Initially, his glycaemic control improved with...
| Main Authors: | , , , , |
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| Format: | Article |
| Language: | English |
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Bioscientifica
2019-04-01
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| Series: | Endocrinology, Diabetes & Metabolism Case Reports |
| Online Access: | https://edm.bioscientifica.com/view/journals/edm/2019/1/EDM19-0008.xml |
| _version_ | 1811228334916370432 |
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| author | Michelle Maher Mohammed Faraz Rafey Helena Griffin Katie Cunningham Francis M Finucane |
| author_facet | Michelle Maher Mohammed Faraz Rafey Helena Griffin Katie Cunningham Francis M Finucane |
| author_sort | Michelle Maher |
| collection | DOAJ |
| description | A 45-year-old man with poorly controlled type 2 diabetes (T2DM) (HbA1c 87 mmol/mol) despite 100 units of insulin per day and severe obesity (BMI 40.2 kg/m2) was referred for bariatric intervention. He declined bariatric surgery or GLP1 agonist therapy. Initially, his glycaemic control improved with dietary modification and better adherence to insulin therapy, but he gained weight. We started a low-energy liquid diet, with 2.2 L of semi-skimmed milk (equivalent to 1012 kcal) per day for 8 weeks (along with micronutrient, salt and fibre supplementation) followed by 16 weeks of phased reintroduction of a normal diet. His insulin was stopped within a week of starting this programme, and over 6 months, he lost 20.6 kg and his HbA1c normalised. However, 1 year later, despite further weight loss, his HbA1c deteriorated dramatically, requiring introduction of linagliptin and canagliflozin, with good response. Five years after initial presentation, his BMI remains elevated but improved at 35.5 kg/m2 and his glycaemic control is excellent with a HbA1c of 50 mmol/mol and he is off insulin therapy. Whether semi-skimmed milk is a safe, effective substrate for carefully selected patients with severe obesity complicated by T2DM remains to be determined. Such patients would need frequent monitoring by an experienced multidisciplinary team. |
| first_indexed | 2024-04-12T09:56:14Z |
| format | Article |
| id | doaj.art-43a262b4706a4e31b59e37a35df6ef2a |
| institution | Directory Open Access Journal |
| issn | 2052-0573 2052-0573 |
| language | English |
| last_indexed | 2024-04-12T09:56:14Z |
| publishDate | 2019-04-01 |
| publisher | Bioscientifica |
| record_format | Article |
| series | Endocrinology, Diabetes & Metabolism Case Reports |
| spelling | doaj.art-43a262b4706a4e31b59e37a35df6ef2a2022-12-22T03:37:40ZengBioscientificaEndocrinology, Diabetes & Metabolism Case Reports2052-05732052-05732019-04-01111410.1530/EDM-19-0008Utilising a milk-based meal replacement programme in a bariatric patient with poorly controlled type 2 diabetes mellitusMichelle Maher0Mohammed Faraz Rafey1Helena Griffin2Katie Cunningham3Francis M Finucane4Bariatric Medicine Service, Centre for Diabetes, Endocrinology and Metabolism, Galway University Hospitals, Galway, IrelandBariatric Medicine Service, Centre for Diabetes, Endocrinology and Metabolism, Galway University Hospitals, Galway, Ireland; HRB Clinical Research Facility, National University of Ireland Galway, Galway, IrelandBariatric Medicine Service, Centre for Diabetes, Endocrinology and Metabolism, Galway University Hospitals, Galway, IrelandBariatric Medicine Service, Centre for Diabetes, Endocrinology and Metabolism, Galway University Hospitals, Galway, IrelandBariatric Medicine Service, Centre for Diabetes, Endocrinology and Metabolism, Galway University Hospitals, Galway, Ireland; HRB Clinical Research Facility, National University of Ireland Galway, Galway, IrelandA 45-year-old man with poorly controlled type 2 diabetes (T2DM) (HbA1c 87 mmol/mol) despite 100 units of insulin per day and severe obesity (BMI 40.2 kg/m2) was referred for bariatric intervention. He declined bariatric surgery or GLP1 agonist therapy. Initially, his glycaemic control improved with dietary modification and better adherence to insulin therapy, but he gained weight. We started a low-energy liquid diet, with 2.2 L of semi-skimmed milk (equivalent to 1012 kcal) per day for 8 weeks (along with micronutrient, salt and fibre supplementation) followed by 16 weeks of phased reintroduction of a normal diet. His insulin was stopped within a week of starting this programme, and over 6 months, he lost 20.6 kg and his HbA1c normalised. However, 1 year later, despite further weight loss, his HbA1c deteriorated dramatically, requiring introduction of linagliptin and canagliflozin, with good response. Five years after initial presentation, his BMI remains elevated but improved at 35.5 kg/m2 and his glycaemic control is excellent with a HbA1c of 50 mmol/mol and he is off insulin therapy. Whether semi-skimmed milk is a safe, effective substrate for carefully selected patients with severe obesity complicated by T2DM remains to be determined. Such patients would need frequent monitoring by an experienced multidisciplinary team.https://edm.bioscientifica.com/view/journals/edm/2019/1/EDM19-0008.xml |
| spellingShingle | Michelle Maher Mohammed Faraz Rafey Helena Griffin Katie Cunningham Francis M Finucane Utilising a milk-based meal replacement programme in a bariatric patient with poorly controlled type 2 diabetes mellitus Endocrinology, Diabetes & Metabolism Case Reports |
| title | Utilising a milk-based meal replacement programme in a bariatric patient with poorly controlled type 2 diabetes mellitus |
| title_full | Utilising a milk-based meal replacement programme in a bariatric patient with poorly controlled type 2 diabetes mellitus |
| title_fullStr | Utilising a milk-based meal replacement programme in a bariatric patient with poorly controlled type 2 diabetes mellitus |
| title_full_unstemmed | Utilising a milk-based meal replacement programme in a bariatric patient with poorly controlled type 2 diabetes mellitus |
| title_short | Utilising a milk-based meal replacement programme in a bariatric patient with poorly controlled type 2 diabetes mellitus |
| title_sort | utilising a milk based meal replacement programme in a bariatric patient with poorly controlled type 2 diabetes mellitus |
| url | https://edm.bioscientifica.com/view/journals/edm/2019/1/EDM19-0008.xml |
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