Long term remission of diabetes

Georgepds

Well-Known Member
Long term remission of diabetes

So it looks like I have a 50 50 chance...


"A small, single-center randomized trial of patients with obesity and advanced type 2 diabetes, defined as diabetes for ≥ 5 years and A1c ≥ 7%, found that a quarter to a half of patients who had metabolic surgery had diabetes remission (cure) that lasted 5 to 9 years.

"That is, of the 60 randomized patients, 50% who had biliopancreatic diversion and 25% who had Roux-en-Y gastric bypass — but none who had received current medical therapy — still had diabetes remission a decade later.
 

Munchkin

Full of Fairy Dust
If you just look at traditional DS patients, your odds are better. The success of the RNY folks is more dependent on weight loss than metabolic change. The standard proximal RNY has little long term malabsorbtion. By the 2 year mark, most patients have adapted to the bypass. This is when the regain starts.

Most DS patients lose the type 2 immediately. Before there is significant weight loss. Baltasar started doing the DS for diabetes in 98 and his success rate was 100% and it was still 100% in 2008. No remissions. I remember a paper published by a doc named Noyes some years ago. I believe it was the first one published about the DS for diabetes. Scopinaro said at an ASMBS conference several years ago it was a cure and the odds were about 96%.
 

Georgepds

Well-Known Member
I was aware of some of the previous work, T2 remission was a major motive for me to get DS,I only wish that I did it earlier. I knew about it in 2007 following the diabetes forums posts of a woman who called herself jillybean.

One thing I recall was the longer the T2 diagnosis before DS, the less likely the recovery, this study puts a number on that. The other issue this article covers is , previously, there has been little formal documentation of long term remission (10 vs 5 year studies)
 

Munchkin

Full of Fairy Dust
Once upon a time I was contacted by a friend of a friend. He was an ophthalmologist so he knew what his severe type 2 was doing to him. He actually called to ask me to go out to dinner with him. He needed to see for himself if I could still eat. I laughed and I went. We met at an all you can eat steak place. He chose and it was quite intentional. I guess I ate enough so he went ahead and had his surgery. In the next few years I got to know both him and his wife pretty well. His wife weighed about 90lbs soaking wet. Her total intake per week was probably a chicken wing.

His type 2 was way out of control. He used 2 different kinds of insulin at least 3 times a day and took oral meds twice a day. He was in serious trouble. He was a volume eater. He ate constantly. I urged him to get into therapy for his eating disorder because even the DS won't work if you eat constantly. Postop it took him a few months to get off the meds but he did. He did drop a lot of weight but I was the one who kept reminding him that his eating habits needed to change to be successful long term. He never did get thin. But he is certainly better off. The DS bought him a retirement instead of early death. The last I heard he was still diabetes free. But to be honest he is one of the ones I think will become diabetic again. I hope I am wrong.
 

Georgepds

Well-Known Member
Insulin use is one of the markers of advanced diabetes in these studies. I know there is a group of diabetics who pride themselves on judicious use of insulin ( a necessity for T1), but for the hoi poli, it's just an indicator that things have gotten out of hand, and the doc has called in the calvary.

Myself, I was close, but no banana, 4 meds , one of which was a secretagogue
 

southernlady

Administrator
Staff member
Insulin use is one of the markers of advanced diabetes in these studies. I know there is a group of diabetics who pride themselves on judicious use of insulin ( a necessity for T1), but for the hoi poli, it's just an indicator that things have gotten out of hand, and the doc has called in the calvary.

Myself, I was close, but no banana, 4 meds , one of which was a secretagogue
While mine was only in remission for 6 years after my DS, my early use of insulin was brought about by my education of not waiting til it’s the “last resort”. At the time, my a1c was just over a 7. My pcp wanted me to try another drug. I told him no as I was on 4 already and having been on a listserv for diabetes for over 5 years, I knew insulin was not the last ditch effort. I chose it, I wasn’t forced into it. even now, I’m on metformin as it is one of the oldest drugs and the only side effect I ever had from it was gastric distress. Yogurt was my solution for that. I’ve told my pcp that if the diabetes proves it needs more than metformi, I will go back to insulin or one of the insulin analogs.
 

Georgepds

Well-Known Member
Thoughtful consideration of the possibilities is one mark of people who choose this (insulin) route. But, far from the forums where people discuss the fine points of diet and meds are the T2 folks who think "what now? I gotta deal with this too. Doc... give me a pill ( or shot in ths case)"

That is what I meant by hoi poli.
 

hilary1617

First time at the rodeo.
On a tangent... have you seen this? https://www.washingtonpost.com/health/2021/02/01/covid-new-onset-diabetes New diabetes cases linked to covid-19 Researchers don’t understand exactly how the disease might trigger Type 1 or Type 2 diabetes, or whether the cases are temporary or permanent. But 14 percent of those with severe covid-19 developed a form of the disorder, one analysis found. By Erin Blakemore Feb. 1, 2021 at 12:15 p.m. CST Mihail Zilbermint is used to treating diabetes — he heads a special team that cares for patients with the metabolic disorder at Suburban Hospital in Bethesda, Md. But as the hospital admitted increasing numbers of patients with covid-19, his caseload ballooned. “Before, we used to manage maybe 18 patients per day,” he said. Now his team cares for as many as 30 daily. Many of those patients had no prior history of diabetes. Some who developed elevated blood sugar while they had covid-19, the illness caused by the novel coronavirus, returned to normal by the time they left the hospital. Others went home with a diagnosis of full-blown diabetes. “We’ve definitely seen an uptick in patients who are newly diagnosed,” Zilbermint said. Although covid-19 often attacks the lungs, it is increasingly associated with a range of problems including blood clots, neurological disorders, and kidney and heart damage. Researchers say new-onset diabetes may soon be added to those complications — both Type 1, in which people cannot make the insulin needed to regulate their blood sugar, and Type 2, in which they make too little insulin or become resistant to their insulin, causing their blood sugar levels to rise. But scientists do not know whether covid-19 might hasten already developing problems or actually cause them — or both. As early as January 2020, doctors in Wuhan, China, noticed elevated blood sugar in patients with covid-19. Physicians in Italy, another early hot spot, wondered whether diabetes diagnoses might follow, given the long-observed association between viral infections and the onset of diabetes. That association was seen in past outbreaks of other coronavirus illnesses such as SARS. A year after the pandemic began, the precise nature and scope of the covid-diabetes link remain a mystery. Many of those who develop diabetes during or after covid-19 have risk factors, such as obesity or a family history of the disease. Elevated blood glucose levels also are common among those taking dexamethasone, a steroid that is a front-line treatment for covid-19. But cases also have occurred in patients with no known risk factors or prior health concerns. And some cases develop months after the body has cleared the virus. John Kunkel, a 47-year-old banking executive in Evening Shade, Ark., was one of the surprise cases. He was hospitalized with covid-19 in early July. During a follow-up visit with his doctor, he learned he had dangerously high blood glucose levels and was readmitted. Kunkel has since received a diagnosis of Type 2 diabetes. “I had no preexisting health issues,” he said. “I was blown away. Why?” Kunkel has had five emergency room visits and three hospital stays since getting covid-19. He recently lost his job because he was unable to return to work, given his continuing health problems. “Will you get your life back?” he asked. “Nobody knows.” As many as 14.4 percent of people hospitalized with severe covid-19 developed diabetes, according to a global analysis published Nov. 27 in the journal Diabetes, Obesity and Metabolism. The international group of researchers sifted through reports of uncontrolled hyperglycemia, or high blood sugar, in more than 3,700 covid-19 patients across eight studies. While those diagnoses might be the result of a long-observed response to severe illness, or to treatment with steroids, the authors wrote, a direct effect from covid-19 “should also be considered.” Concerns that covid-19 might be directly implicated also were supported, they said, by the exceptionally high doses of insulin that diabetes patients with severe covid-19 often require and the dangerous complications they develop. Researchers do not understand exactly how covid-19 might trigger Type 1 or Type 2 diabetes, or whether the cases are temporary or permanent. But they are racing to find answers to these and other questions, including whether the novel coronavirus may have spawned an entirely new type of diabetes that might play out differently from the traditional forms of the disease. Francesco Rubino, a diabetes surgery professor at King’s College London, is convinced there is an underlying connection between the diseases. Over the summer, he and a group of other diabetes experts launched a global registry of patients with covid-19-related diabetes. After they spread the word with an editorial in the New England Journal of Medicine, more than 350 institutions from across the world responded, he said. The database is accumulating patients — over 150 so far — although it will take months for researchers to sift through the data to draw any conclusions. “We really need to dig deeper,” Rubino said. “But it sounds like we do have a real problem with covid and diabetes.” Some of the cases reported to his database do not fit the usual profile of Type 1 diabetes, in which the pancreas produces little or no insulin, or Type 2, in which people become insulin resistant, he said. Usually, a patient with one type of diabetes will experience specific complications; for instance, those with Type 1 may burn through their fat stores, or those with Type 2 may experience a syndrome that can involve severe dehydration and coma as the body pumps excess blood sugar into the urine. In some patients with covid-19, though, complications cross types. “There’s a good chance that the mechanism of the diabetes isn’t typical,” Rubino said. “There could be a hybrid form. It’s concerning.” Rubino is especially worried about reports of diabetes diagnoses after mild or asymptomatic coronavirus infections. As the number of novel coronavirus infections continues to rise, he said, “you could see a significant new volume of diabetes diagnoses.” Diabetes already is increasing at an alarming rate in the United States. An estimated 34.2 million people, or 10.5 percent of the population, have the disorder, according to federal health data. And approximately 1 in 3 Americans, or 88 million people, have prediabetes, which indicates they are on a path to Type 2. If left uncontrolled, the disease can damage many parts of the body and is associated with serious complications including heart disease, stroke, blindness, kidney failure and nerve damage. But whether those with diabetes that is newly diagnosed after covid-19 will have a lifelong problem is unclear. After the 2003 SARS pandemic, Chinese researchers tracked 39 patients with no history of diabetes who had developed acute diabetes within days of hospitalization with SARS. For all but six, blood sugar level had fallen by the time they were discharged, and only two still had diabetes after two years. The researchers also found evidence that the SARS virus might attack insulin-producing beta cells in the pancreas. Beta cells play starring roles in both types of diabetes: The bodies of those with Type 1 attack and destroy the cells altogether, halting insulin production. Type 2 diabetics become resistant to the insulin they produce, so the beta cells make more and more, and eventually are worn out. “If scientists could figure out how or if viral infection can damage beta cells, or what role viruses play in the development of the disease, it would be a real turning point,” said Katie Colbert Coate, a diabetes researcher and research instructor in medicine at Vanderbilt University Medical Center. Though people with diabetes are no more susceptible to contracting covid-19 than those without, they are at much higher risk of severe complications or death once they do. In the early days of the pandemic, just over a third of those who died of covid-19 in British hospitals had preexisting cases of diabetes. Doctors in Wuhan also noticed that those with newly diagnosed diabetes were more likely to need intensive care than those who had diabetes before they contracted covid-19. New diagnoses of diabetes in people with no classic risk factors also are scattered throughout case reports: A 37-year-old, previously healthy Chinese man who went to the hospital with a severe, and in some cases fatal, diabetes complication; a 19-year-old German who developed Type 1 diabetes five to seven weeks after a novel coronavirus infection but who lacked the antibodies commonly associated with the autoimmune disease. Doctors at Children’s Hospital Los Angeles, meanwhile, noticed an increase in the number of Type 2 diagnoses in children, as well as a severe complication of diabetes. After some of them showed evidence of past coronavirus infections, Senta Georgia, an investigator in the hospital’s Saban Research Institute, began looking deeper. Her research, which repurposes tissue from primates used in vaccine tests, is undergoing peer review. “Only with the scientific public square can we put all of this data out there, evaluate its strengths and weaknesses … until we really get the information we need,” Georgia said. Such reports also have increased the sense of urgency for researchers like Coate, who dropped other work and began looking for keys to understanding the mechanism of the disease by examining how covid-19 might damage beta cells or other structures in the pancreas. She and others are asking whether certain covid symptoms predict whether a patient is vulnerable to diabetes and, most important, whether the disease’s onset is an effect of the immune response or a result of the virus directly attacking insulin-producing cells. ACE2 receptor cells, the novel coronavirus’s entryway into the body, could provide one answer. When the spike proteins that surround the virus latch onto a host cell with an ACE2 receptor, they open up a cellular doorway that allows the virus to hijack the cell. Strong evidence of ACE2 receptors on beta cells could confirm the long-standing suspicion that viruses trigger diabetes. But the research findings are inconclusive: Since the pancreas breaks down quickly after death, obtaining good samples from autopsied humans is difficult. And each study has its own limitations. Last year, Cornell University researchers grew human pancreas cells and managed to infect them with SARS-CoV-2, as the novel coronavirus is technically known. They found ACE2 receptors on the cells, but the cells had been cultivated in a laboratory, not a human body. Coate and her colleagues at Vanderbilt University were able to confirm the presence of ACE2 receptors in the physical structures of the pancreas, but their study focused on patients without covid-19 and found no evidence of the receptors on the insulin-producing beta cells. An Italian study did find the receptors in beta cells, but the donors did not have covid-19, either. Until receptors in pancreatic beta cells in tissue from covid-19 patients can be consistently confirmed by other researchers, the hunt for the mechanism underlying the diabetes-covid-19 connection continues. So does research on ways covid-19 might harm other parts of the endocrine system, which also might play a role in the disease mechanism. For newly diagnosed patients such as nurse practitioner Tanisha Flowers, the answers can’t come soon enough. Infected in April while working in a covid-19 ward in a Richmond hospital, the 40-year-old was diagnosed with diabetes in October. She now takes daily medications, watches her diet and is all too aware that she may be diabetic for life. “I’m not myself anymore,” Flowers said. “No one knows what the lasting outcomes are.” ***
 
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Georgepds

Well-Known Member
Had not seen that one

Re "Elevated blood glucose levels also are common among those taking dexamethasone, a steroid that is a front-line treatment for covid-19. "
Back when my T2 was active I occasionally had a dex injection for an ear problem. Whooo.. it would send my BG through the roof for days


It is such a complicated disease. I'm happy the DS gave me remission, even if only for a while. It sets the clock back on all the other scary killer co-morbidities that develop with it
 

MsVee

Well-Known Member
On a tangent... have you seen this? https://www.washingtonpost.com/health/2021/02/01/covid-new-onset-diabetes New diabetes cases linked to covid-19 Researchers don’t understand exactly how the disease might trigger Type 1 or Type 2 diabetes, or whether the cases are temporary or permanent. But 14 percent of those with severe covid-19 developed a form of the disorder, one analysis found. By Erin Blakemore Feb. 1, 2021 at 12:15 p.m. CST Mihail Zilbermint is used to treating diabetes — he heads a special team that cares for patients with the metabolic disorder at Suburban Hospital in Bethesda, Md. But as the hospital admitted increasing numbers of patients with covid-19, his caseload ballooned. “Before, we used to manage maybe 18 patients per day,” he said. Now his team cares for as many as 30 daily. Many of those patients had no prior history of diabetes. Some who developed elevated blood sugar while they had covid-19, the illness caused by the novel coronavirus, returned to normal by the time they left the hospital. Others went home with a diagnosis of full-blown diabetes. “We’ve definitely seen an uptick in patients who are newly diagnosed,” Zilbermint said. Although covid-19 often attacks the lungs, it is increasingly associated with a range of problems including blood clots, neurological disorders, and kidney and heart damage. Researchers say new-onset diabetes may soon be added to those complications — both Type 1, in which people cannot make the insulin needed to regulate their blood sugar, and Type 2, in which they make too little insulin or become resistant to their insulin, causing their blood sugar levels to rise. But scientists do not know whether covid-19 might hasten already developing problems or actually cause them — or both. As early as January 2020, doctors in Wuhan, China, noticed elevated blood sugar in patients with covid-19. Physicians in Italy, another early hot spot, wondered whether diabetes diagnoses might follow, given the long-observed association between viral infections and the onset of diabetes. That association was seen in past outbreaks of other coronavirus illnesses such as SARS. A year after the pandemic began, the precise nature and scope of the covid-diabetes link remain a mystery. Many of those who develop diabetes during or after covid-19 have risk factors, such as obesity or a family history of the disease. Elevated blood glucose levels also are common among those taking dexamethasone, a steroid that is a front-line treatment for covid-19. But cases also have occurred in patients with no known risk factors or prior health concerns. And some cases develop months after the body has cleared the virus. John Kunkel, a 47-year-old banking executive in Evening Shade, Ark., was one of the surprise cases. He was hospitalized with covid-19 in early July. During a follow-up visit with his doctor, he learned he had dangerously high blood glucose levels and was readmitted. Kunkel has since received a diagnosis of Type 2 diabetes. “I had no preexisting health issues,” he said. “I was blown away. Why?” Kunkel has had five emergency room visits and three hospital stays since getting covid-19. He recently lost his job because he was unable to return to work, given his continuing health problems. “Will you get your life back?” he asked. “Nobody knows.” As many as 14.4 percent of people hospitalized with severe covid-19 developed diabetes, according to a global analysis published Nov. 27 in the journal Diabetes, Obesity and Metabolism. The international group of researchers sifted through reports of uncontrolled hyperglycemia, or high blood sugar, in more than 3,700 covid-19 patients across eight studies. While those diagnoses might be the result of a long-observed response to severe illness, or to treatment with steroids, the authors wrote, a direct effect from covid-19 “should also be considered.” Concerns that covid-19 might be directly implicated also were supported, they said, by the exceptionally high doses of insulin that diabetes patients with severe covid-19 often require and the dangerous complications they develop. Researchers do not understand exactly how covid-19 might trigger Type 1 or Type 2 diabetes, or whether the cases are temporary or permanent. But they are racing to find answers to these and other questions, including whether the novel coronavirus may have spawned an entirely new type of diabetes that might play out differently from the traditional forms of the disease. Francesco Rubino, a diabetes surgery professor at King’s College London, is convinced there is an underlying connection between the diseases. Over the summer, he and a group of other diabetes experts launched a global registry of patients with covid-19-related diabetes. After they spread the word with an editorial in the New England Journal of Medicine, more than 350 institutions from across the world responded, he said. The database is accumulating patients — over 150 so far — although it will take months for researchers to sift through the data to draw any conclusions. “We really need to dig deeper,” Rubino said. “But it sounds like we do have a real problem with covid and diabetes.” Some of the cases reported to his database do not fit the usual profile of Type 1 diabetes, in which the pancreas produces little or no insulin, or Type 2, in which people become insulin resistant, he said. Usually, a patient with one type of diabetes will experience specific complications; for instance, those with Type 1 may burn through their fat stores, or those with Type 2 may experience a syndrome that can involve severe dehydration and coma as the body pumps excess blood sugar into the urine. In some patients with covid-19, though, complications cross types. “There’s a good chance that the mechanism of the diabetes isn’t typical,” Rubino said. “There could be a hybrid form. It’s concerning.” Rubino is especially worried about reports of diabetes diagnoses after mild or asymptomatic coronavirus infections. As the number of novel coronavirus infections continues to rise, he said, “you could see a significant new volume of diabetes diagnoses.” Diabetes already is increasing at an alarming rate in the United States. An estimated 34.2 million people, or 10.5 percent of the population, have the disorder, according to federal health data. And approximately 1 in 3 Americans, or 88 million people, have prediabetes, which indicates they are on a path to Type 2. If left uncontrolled, the disease can damage many parts of the body and is associated with serious complications including heart disease, stroke, blindness, kidney failure and nerve damage. But whether those with diabetes that is newly diagnosed after covid-19 will have a lifelong problem is unclear. After the 2003 SARS pandemic, Chinese researchers tracked 39 patients with no history of diabetes who had developed acute diabetes within days of hospitalization with SARS. For all but six, blood sugar level had fallen by the time they were discharged, and only two still had diabetes after two years. The researchers also found evidence that the SARS virus might attack insulin-producing beta cells in the pancreas. Beta cells play starring roles in both types of diabetes: The bodies of those with Type 1 attack and destroy the cells altogether, halting insulin production. Type 2 diabetics become resistant to the insulin they produce, so the beta cells make more and more, and eventually are worn out. “If scientists could figure out how or if viral infection can damage beta cells, or what role viruses play in the development of the disease, it would be a real turning point,” said Katie Colbert Coate, a diabetes researcher and research instructor in medicine at Vanderbilt University Medical Center. Though people with diabetes are no more susceptible to contracting covid-19 than those without, they are at much higher risk of severe complications or death once they do. In the early days of the pandemic, just over a third of those who died of covid-19 in British hospitals had preexisting cases of diabetes. Doctors in Wuhan also noticed that those with newly diagnosed diabetes were more likely to need intensive care than those who had diabetes before they contracted covid-19. New diagnoses of diabetes in people with no classic risk factors also are scattered throughout case reports: A 37-year-old, previously healthy Chinese man who went to the hospital with a severe, and in some cases fatal, diabetes complication; a 19-year-old German who developed Type 1 diabetes five to seven weeks after a novel coronavirus infection but who lacked the antibodies commonly associated with the autoimmune disease. Doctors at Children’s Hospital Los Angeles, meanwhile, noticed an increase in the number of Type 2 diagnoses in children, as well as a severe complication of diabetes. After some of them showed evidence of past coronavirus infections, Senta Georgia, an investigator in the hospital’s Saban Research Institute, began looking deeper. Her research, which repurposes tissue from primates used in vaccine tests, is undergoing peer review. “Only with the scientific public square can we put all of this data out there, evaluate its strengths and weaknesses … until we really get the information we need,” Georgia said. Such reports also have increased the sense of urgency for researchers like Coate, who dropped other work and began looking for keys to understanding the mechanism of the disease by examining how covid-19 might damage beta cells or other structures in the pancreas. She and others are asking whether certain covid symptoms predict whether a patient is vulnerable to diabetes and, most important, whether the disease’s onset is an effect of the immune response or a result of the virus directly attacking insulin-producing cells. ACE2 receptor cells, the novel coronavirus’s entryway into the body, could provide one answer. When the spike proteins that surround the virus latch onto a host cell with an ACE2 receptor, they open up a cellular doorway that allows the virus to hijack the cell. Strong evidence of ACE2 receptors on beta cells could confirm the long-standing suspicion that viruses trigger diabetes. But the research findings are inconclusive: Since the pancreas breaks down quickly after death, obtaining good samples from autopsied humans is difficult. And each study has its own limitations. Last year, Cornell University researchers grew human pancreas cells and managed to infect them with SARS-CoV-2, as the novel coronavirus is technically known. They found ACE2 receptors on the cells, but the cells had been cultivated in a laboratory, not a human body. Coate and her colleagues at Vanderbilt University were able to confirm the presence of ACE2 receptors in the physical structures of the pancreas, but their study focused on patients without covid-19 and found no evidence of the receptors on the insulin-producing beta cells. An Italian study did find the receptors in beta cells, but the donors did not have covid-19, either. Until receptors in pancreatic beta cells in tissue from covid-19 patients can be consistently confirmed by other researchers, the hunt for the mechanism underlying the diabetes-covid-19 connection continues. So does research on ways covid-19 might harm other parts of the endocrine system, which also might play a role in the disease mechanism. For newly diagnosed patients such as nurse practitioner Tanisha Flowers, the answers can’t come soon enough. Infected in April while working in a covid-19 ward in a Richmond hospital, the 40-year-old was diagnosed with diabetes in October. She now takes daily medications, watches her diet and is all too aware that she may be diabetic for life. “I’m not myself anymore,” Flowers said. “No one knows what the lasting outcomes are.” ***
I am not surprised. My brother David has a close friend who had COVID-19 who is now diabetic. His friend was hospitalized twice. He now has diabetes, kidney issues and requires oxygen because he has suffered permanent lung damage.

They met at the gym because they are both serious about exercising and fitness. Before he caught the virus he had no underlying health issues. He had undergone a full physical approximately 8 weeks before his COVID-19 diagnosis. I think the narrative about people with underlying health conditions makes us feel better. I don’t think they really know who this virus attacks or why some people suffer death or life altering damage to their health.
 
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