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EN
The idea of surgical treatment of type 2 diabetes was established in the U.S. and was based on observation of patients after bariatric operations. Performed in cases of morbid obesity exclusion of the duodenum and anastomose the stomach with the central part of the intestines cause shortened absorbtion of nutrients, what showed a beneficial effect on weight loss, resolution of comorbidities and reduce the risk of developing cardiovascular diseases and cancer. Analysis of the results of surgical treatment of obese patients with type 2 diabetes confirmed the usefulness of surgical methods.The aim of the study was to evaluate the impact of Roux-en-Y gastric by-pass (RYGB) on diabetes in patients with BMI below and above 35 kg/m2.Material and methods. The study comprised 66 patients with DM2, who underwent Roux-en-Y gastric bypass due to morbid obesity (BMI above 35 kg/m2) and three patients with DM2 and BMI below 35 kg/m2. In patients with DM2 and BMI < 35 kg/m2 criteria for inclusion in the operational treatment were: DM2 difficult to be regulated pharmacologically lasting less than 10 years and BMI at the qualification about 35 kg/m2. Indications have been determined on the basis of three consecutive measurements of HbA1c values above 7%, and measurements of blood glucose (frequent fluctuations in blood glucose levels on the value of hypoglycemia to hyperglycemia).Results. The criteria for diagnosing resolution of DM2 included the level of HbA1c < 6% and glucose fasting level below 100 mg/ dl. In a group of 66 patients with DM2 and obesity, regression of DM2 was observed in 48 patients (73%) as early as during the hospitalization. In 11 patients (16.7%) glycaemia and HBA1c were stabilized within 8 weeks after surgery. In 7 (10.6%) cases of patients with difficult to control DM2, there was still need for antidiabetic medication, but glycemic control was much more effective. After one year remission was observed in 89% of patients. In all three patients with DM2 and BMI < 35 kg/m2 total glycemic resolution of DM2 was observed during hospitalization. In this group there has been no postoperative complications. In the group of 66 obese patients with DM2 postoperative complications were found in 7 cases, they were related to infection and prolonged healing of surgical wound. One patient had an intraabdominal abscess located in the left subphrenic region, it was punctured under ultrasound guidance.Conclusions. The ultimate evaluation of this method demands several years of meticulous clinical studies. Despite of that, considering high cost of life-long conservative therapy of DM2 and its complications, severe impact on quality of life and serious consequences of the disease, the surgical metabolic intervention may become the most resonable solution in many cases.
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issue 73
53-59
EN
The steady increase in the incidence of type 2 diabetes, which is the leading cause of end-stage renal failure among hemodialysis patients, has been the subject of multidisciplinary research. Much attention has been devoted to the effects of hemodialysis on blood glucose fluctuations during hemodialysis and intervals between treatments, as well as differences in glycemic variability in patients with and without diabetes mellitus. A large group of studies is those related to methods of monitoring glucose levels and the usefulness of individual biomarkers. The results clearly show the significant and different effects of hemodialysis on glycemic dysfunction in people with and without diabetes. It has also been shown that due to the numerous interfering factors, the usefulness of HbA1c to monitor glucose levels in hemodialysis patients is lower compared to non-demyelised individuals, but still remains the primary biomarker for glucose monitoring. Research has also become a method of treating diabetes in hemodialysis patients, dietary recommendations and an attempt to develop standards for the care of hemodialysis patients. The results of individual studies on obesity and dietary recommendation remain unchanged, suggesting a positive effect on the quality of life, renal failure, and hemodialysis itself. These results have not yet been confirmed by subsequent studies.
PL
Stały wzrost zapadalności na cukrzycę typu 2, będącą główną przyczyną schyłkowej niewydolności nerek u chorych hemodializowanych, stał się przedmiotem wielokierunkowych badań. Wiele uwagi poświęcono wpływowi hemodializy na wahania glikemii w trakcie zabiegu hemodializy oraz w okresach między zabiegami, jak również na różnice między zmiennością glikemii u chorych z rozpoznaną cukrzycą oraz bez tego schorzenia. Dużą grupę stanowią badania dotyczące metod monitorowania poziomu glikemii oraz przydatności poszczególnych biomarkerów. Wyniki badań jednoznacznie wykazują istotny oraz odmienny wpływ hemodializy na zmienność glikemii u osób z cukrzycą oraz bez tego schorzenia. Wykazano również, że z uwagi na liczne czynniki interferujące przydatność HbA1c do monitorowania poziomu glikemii u chorych hemodializowanych jest mniejsza niż u osób niehemodializowanych, nadal jednak pozostaje ona głównym biomarkerem służącym do monitorowania poziomu glikemii. Przedmiotem badań stały się również metody leczenia cukrzycy u chorych hemodializowanych, zalecenia dietetyczne oraz próba opracowania standardów opieki nad tymi chorymi. Wyniki pojedynczych badań nad otyłością i zaleceniami dietetycznymi różnią się od pozostałych, sugerując korzystny wpływ na jakość życia chorych, przebieg niewydolności nerek oraz sam zabieg hemodializy. Wyniki te nie zostały dotychczas potwierdzone.
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