Diabetes develop various complications that require surgical treatment. It is hard for the internist and surgeon to agree when surgery may be safely done in the severe diabetic. There is no actual need for normoglycemia nor for the over-enthusiasm in bringing glucose level to normal to the extent that other metabolic and biochemical defects are forgotten. (Author)
Human ; SURGERY ; DIABETES COMPLICATIONS

Diabetes Mellitus, Type 2 ; complications ; drug therapy ; surgery ; Humans ; Obesity ; complications ; drug therapy ; surgery

Chronic hyperglycemia is the primary risk factor for the development of complications in diabetes mellitus (DM); however, it is believed that frequent or large glucose fluctuations may independently contribute to diabetes-related complications. Postprandial spikes in blood glucose, as well as hypoglycemic events, are blamed for increased cardiovascular events in DM. Glycemic variability (GV) includes both of these events; hence, minimizing GV can prevent future cardiovascular events. Correcting GV emerges as a target to be pursued in clinical practice to safely reduce the mean blood glucose and to determine its direct effects on vascular complications in diabetes. Modern diabetes management modalities, including glucagon-related peptide-1-based therapy, newer insulins, modern insulin pumps and bariatric surgery, significantly reduce GV. However, defining GV remains a challenge primarily due to the difficulty of measuring it and the lack of consensus regarding the optimal approach for its management. The purpose of this manuscript was not only to review the most recent evidence on GV but also to help readers better understand the available measurement options and how the various definitions relate differently to the development of diabetic complications.
Bariatric Surgery ; Blood Glucose ; Consensus ; Diabetes Complications ; Diabetes Mellitus ; Glucose ; Hyperglycemia ; Insulin ; Insulins ; Risk Factors

Bariatric surgery is one of the most effective treatment options for obesity and type 2 diabetes mellitus. In recent years, laparoscopic sleeve gastrectomy has become increasingly popular due to simple operation, high safety and significant efficacy. In this article, the progress and the application evaluation of laparoscopic sleeve gastrectomy for the treatment of obesity and type 2 diabetes mellitus in the field of bariatric and metabolic surgery are reviewed.
Bariatric Surgery ; Diabetes Mellitus, Type 2 ; complications ; Gastrectomy ; Humans ; Laparoscopy ; Obesity, Morbid ; complications ; Treatment Outcome

Total pancreatectomy has been mainly used to treat malignant diseases of the pancreas, di-ffuse ductal involvement, and severe chronic pancreatitis. Patients may develop pancreatic diabetes after the surgery, in whom the glucose levels fluctuate widely and are hard to control, which increases the incidence of recurrent hypoglycemia. Postoperative complications are closely associated with the glucose levels. Thus, tighter glycemic management is essential for increasing the survival of these patients. Few cases have been discribed in China. In this article, we reviewed the blood glucose features, peri- and post-operative complications, and clinical treatment for patients undergoing total pancreatectomy.
Blood Glucose ; analysis ; China ; Diabetes Mellitus ; Humans ; Pancreas ; surgery ; Pancreatectomy ; Pancreatic Neoplasms ; surgery ; Postoperative Complications

Gastric surgery can reduce the body weight in obese patients with type 2 diabetes and decrease their blood glucose. In the latter, incretins may play certain roles.
Diabetes Mellitus, Type 2 ; etiology ; surgery ; Gastric Bypass ; Humans ; Obesity, Morbid ; complications ; surgery ; Treatment Outcome

Bariatric Surgery ; adverse effects ; Diabetes Mellitus, Type 2 ; complications ; prevention & control ; Humans ; Obesity, Morbid ; complications ; surgery ; Treatment Outcome ; Weight Loss

OBJECTIVETo evaluate clinical results of plate on the metatarsal side to reconstruction of tarsometatarsal joint dislocations secondary to diabetic charcot foot.

METHODSSeven patients (9 feet) patients with tarsometatarsal joint dislocations secondary to diabetic charcot foot were treated with plating from April 2012 to December 2014. All patients were male, and 5 cases were on the unilateral side and 2 cases were on the bilateral sides. The age of patients ranged from 45 to 52 with an average of 48 years old. The history of diabetics was from 6 to 15 years. X-ray and CT were used to evaluate fractures healing,and AOFAS was applied to estimate recovery of joint function.

RESULTSAll patients were followed up from 12 to 24 months with an average of 19 months. All incisions were healed at stage I . No infection, loosening and breakage of internal fixation, bone nonunion were found after operation. According to postoperative X-ray and CT results, the time of fracture healing ranged from 10 to 20 weeks with an average of 16 weeks. Six feet got excellent results, 2 good and 1 moderate based on AOFAS scoring.

CONCLUSIONTarsometatarsal joint dislocations secondary to diabetic charcot foot treated with plate on the metatarsal side could obtain stable fixation and got satisfied early clinical results.

Adult ; Bone Plates ; Diabetes Complications ; surgery ; Diabetes Mellitus, Type 2 ; complications ; Female ; Foot Diseases ; etiology ; surgery ; Fracture Fixation, Internal ; Humans ; Joint Dislocations ; surgery ; Male ; Metatarsal Bones ; surgery ; Middle Aged ; Tarsal Joints ; surgery

Adult ; Diabetes Mellitus ; etiology ; Humans ; Male ; Nose Diseases ; etiology ; surgery ; Pancreatitis ; complications ; Reconstructive Surgical Procedures ; Ulcer

OBJECTIVETo explore significance of preoperative color Doppler flow imaging (CDFI) for screening deep vein thrombosis in upper limbs fracture.

METHODSFrom January 2009 to December 2011, 1200 patients with upper limb fracture caused by trauma were respectively analyzed. There were 833 males and 367 females,ranging from 20 to 78 (mean 41.94 +/- 15.41) years. All patients had swelling and pain in injured limbs when enrolled. CDFI was used to examine upper limbs vein at 3 to 10 d after improvement of swelling, 1 day before reduction. Relationship among occurrence of thrombosis, gender, age and fracture sites were analyzed. Patients with DVT were analyzed with respective study to decide whether combined with diabetes, hypertension and hyperlipidemia.

RESULTSAll patients were checked by CDFI,which confirmed 9 cases with DVT. The rate of thrombosis was 0.75%, women than men (P < 0.01). The risk of blood clots occurred over 30 years, and the occurrence of thrombosis in humerus fracture was higher than radius ulnar fracture. One of 9 patients combined with hypertension and hyperlipidemia, 1 case combined with diabetes, and 7 cases with no complication.

CONCLUSIONUpper trauma fracture may occur deep vein thrombosis; CDFI should be used to check DVT in qualified hospital,which can maintain medical safety,decrease occurrence of medical disputes, and ganrantee patient's safety.

Adult ; Aged ; Aged, 80 and over ; Diabetes Complications ; surgery ; Female ; Fractures, Bone ; complications ; surgery ; Humans ; Hypercholesterolemia ; complications ; Hypertension ; complications ; Male ; Middle Aged ; Preoperative Period ; Ultrasonography, Doppler, Color ; Upper Extremity ; injuries ; Venous Thrombosis ; complications ; diagnostic imaging ; Young Adult