Impact of Abdominal Subcutaneous Fat Reduction on Glycemic Control in Obese Patients with Type 2 Diabetes Mellitus
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Background: The effect on type 2 diabetes mellitus (T2DM) when adipose tissue is removed is controversial. This study aimed to evaluate and compare the effect of the abdominoplasty and bariatric surgery on glycemic control in patients with T2DM. Methods: Patients with T2DM undergoing abdominoplasty for cosmesis were studied (n = 25). Subjects were 36.9 ± 1.3 years with a preoperative body mass index (BMI) of 40.6 ± 0.5 kg/m2 and mean glycated hemoglobin (HbA1c) of 7.4% ± 0.2%. Fifteen matched patients undergoing bariatric surgery were selected as a comparator group. Weight, BMI, waist circumference (WC), random blood glucose (RBG), and HbA1c were evaluated at baseline and 3, 6, and 12 months postsurgery. Results: By 12 months, abdominoplasty reduced weight by 5.6 ± 0.3 kg p < 0.01), and HbA1c was reduced to 6.8% ± 0.3% (p < 0.01). After 12 months, bariatric surgery reduced BMI from 42.2 ± 1 kg/m2 to 26.6 ± 0.4 kg/m2 (p < 0.01). HbA1c reduced from 7.9% ± 0.4% to 5.5% ± 0.2% (p < 0.01). WC was similar between both groups at 3 months, although HbA1c reductions were superior after bariatric surgery. Conclusions: Reducing subcutaneous adipose tissue with abdominoplasty results in a small improvement in glycemic control in patients with T2DM. Despite equivalent WC at 3 months, bariatric surgery outperformed abdominoplasty on all metabolic parameters then and thereafter.Keywords:
Abdominoplasty
Glycated hemoglobin
Although the level of glycated hemoglobin (HbA 1C ) reflects chronic glycemic control, treatment-induced decreases in HbA 1C in patients who have established diabetes do not always predict beneficial clinical outcomes. Clinical outcomes are dramatically influenced by the history of previous glycemic control, the extent of current clinical complications, and the side effects of therapeutic agents. Rational approaches to the intensity of glycemic control in individual patients should take these factors into consideration, as well as in setting an appropriate goal for the HbA 1C target.
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Background: The question of whether or not abdominoplasty is associated with permanent weight reduction remains controversial. In coalition, should abdominoplasty be used as an adjunct for weight reduction in the overweight/obese patient? Methods: This retrospective patient case series attempts to determine the most important factors associated with weight reduction. Results: All patients undergoing abdominoplasty had weight loss beyond that of their resected pannus, with a minimum body mass index reached 11.6 ± 1.7 weeks after surgery. Weight loss is attributed to an increase in satiety by 75 percent (n = 15) of patients. Preoperative body mass index greater than or equal to 24.5 kg/m2 can be used to predict long-term weight loss with a sensitivity and specificity of 92.9 percent and 83.3 percent, respectively. Patients above this threshold achieved significantly more weight loss (−4.5 ± 1.4 percent body mass index) at 1 year compared with their lower body mass index counterparts (p = 0.014), as did those with pannus resections weighing greater than 4.5 lb (p = 0.01). Conclusions: Abdominoplasty performed on patients with a body mass index greater than 24.5 kg/m2 appears to be linked to sustained weight loss at 1 year. Satiety appears to be a prominent contributing factor, as does the amount of fat resected. Possible neurocrine mechanisms are discussed. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.
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It was a great pleasure to have the opportunity to read the article with title “Correction of Contour Deformity Using Reverse Abdominoplasty Combined with Mini-Abdominoplasty” reported by Yang et al.[1] Authors reported the case of a patient with apparent abdominal wall skin laxity with a compact umbilical area 1 year after liposuction, which was treated with combined reverse abdominoplasty and mini-abdominoplasty, resulting in a satisfactory esthetic outcome. And authors ended up with a following conclusion: “…to our knowledge, this is the first report of combined reverse abdominoplasty and mini-abdominoplasty for the treatment of a characteristic deformity.” Authors have a very interesting and informative article. They also wrote down a very thorough discussion with satisfactory references. They also referred our paper as the reference number 5 as follows: Zienowicz RJ, Karacaoglu E. Augmentation mammaplasty by reverse abdominoplasty (AMBRA). Plast Reconstr Surg 2009;124:166272. doi: 10.1097/PRS.0b013e3181babd02.[2] As it would be clearly seen, we have published a series of 37 cases in our paper with Augmentation Mammaplasty by Reverse Abdominoplasty (AMBRA) technique and we performed full-abdominoplasty in 16 (43%) of cases. It seems to us that authors made unintentional physical error stating that “…to our knowledge, this is the first report of combined reverse abdominoplasty and mini-abdominoplasty for the treatment of a characteristic deformity.” As seen obviously, we performed reverse abdominoplasty with full (more than mini-) abdominoplasty as stated in our article which was published 9 years before the aforementioned article. Author's Reply: Thanks for your attention on our study.[1] We appreciate your questions and opinions. The above comment reported that the reverse abdominoplasty combined with mini (full)-abdomnioplasty have been carried out and reported by other authors before. Thus the statement in our case[1] that “…to our knowledge, this is the first report of combined reverse abdominoplasty and mini-abdominoplasty for the treatment of a characteristic deformity” is unproper. However, in our case, we have made it clear that the patient was a special woman with a characteristic deformity after liposuction. The characteristic deformity owned the feature that “the skin within 2 cm around the umbilicus was in favourable adherence to the underlying fascia, while the rest of the skin was not”. The inherent blood supply around the umbilicus remained well and a regular way of abdominalplasty might be a second time undermining to the residual blood supply. Thus, we tried the reverse abdominoplasty combined with mini-abdomnioplasty to solve the characteristic deformity and got a satisfactory outcome. In the article of Zienowicz el al,[2] such deformity was not mentioned. So this was the first report of utilizing the reverse abdominoplasty combined with mini-abdomnioplasty to solve the characteristic deformity.
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The aim of this study was to investigate the role of irisin in type 2 diabetes mellitus and its association with metabolic alterations and obesity.A cross-sectional case-control study was conducted on participants treated at Centro Universitário FMABC between August 2018 and July 2019, by comparing a control group (n=14) with type 2 diabetes mellitus patients (n=16). The control group consisted of participants aged above 21 years with no chronic diseases, diabetes, smoking, or illicit drug use. The type 2 diabetes mellitus group included patients aged above 21 years, who were diagnosed with type 2 diabetes for at least 5 years (glycated hemoglobin>7%). Exclusion criteria were not willing to continue, recent hospitalization, and failure to meet inclusion criteria. Biochemical parameters included blood glucose, glycated hemoglobin, plasma irisin levels, and irisin gene expression in peripheral blood.Type 2 diabetes mellitus patients exhibited significantly higher plasma glucose levels [143 (40) vs. 92 (13) mg/dL, *p<0.05] and glycated hemoglobin levels [7.1% (1.6) vs. 5.6% (0.5), *p<0.05] compared to the control group. Irisin gene expression in type 2 diabetes mellitus patients was lower 0.02288 (0.08050) than the control group 8.506e-006 (1.412e-005) (p=0.06). Correlation analysis revealed a positive association between irisin expression and body mass index in type 2 diabetes mellitus (Rho=0.5221, 95%CI -0.058 to 0.838, p=0.06), while plasma irisin showed a negative correlation with body mass index (Rho=-0.656, 95%CI -0.836 to 0.215, p=0.03). No significant correlations were found between plasma glucose or glycated hemoglobin levels and irisin expression.The data suggests that body mass index directly influences plasma irisin levels and the regulation of irisin gene expression, possibly linking irisin to adiposity changes observed in obesity-related type 2 diabetes mellitus.
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According to this study: In non-insulin-treated patients who have type 2 diabetes, structured self-monitoring of blood glucose leads to clinically significant improvements in glycated hemoglobin. Patients with suboptimal glycemic control derive the most benefit from self-monitoring.
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Vascular complications of diabetes result from long lasting unsatisfactory glycemic control. We usually assess glycemic control based on the value of glycated hemoglobin HbA1c. The glycated hemoglobin test, however, says nothing about short-term glycemic fluctuations. Recently, continuous monitoring of glycemia has enabled us an in-depth assessment of changes in glucose concentrations, called glycemic variability. Together with the research of short-term glycemic variability, also the study of long-term fluctuations in glycemic control based on HbA1c variability has now intensified. Glycemic variability may be related to oxidation stress, endothelial dysfunction and inflammation, the factors traditionally associated with vascular damage. This overview summarizes the recent findings in the field of glycemic variability and its possible association with microvascular complications in patients with type 1 and type 2 diabetes.Key words: glycemic variability, HbA1c variability, microvascular complications, type 1 and type 2 diabetes mellitus.
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In this study, we investigated which predictors from people with type 1 diabetes at initiation of intensive treatment that increase the risk of not achieving glycemic target. Data from a clinical trial with type 1 diabetes people (n=460) were used in a logistic regression model to analyze the effect of the predictors on achievement of glycemic target. Results indicate that age, smoking, glycated hemoglobin, 1,5-anhydroglucitol and fluctuation from continuous glucose monitoring are predictors of achievement of glycemic target, which can be used in an algorithm to predict people who fail to achieve glycemic target.
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