CASE REPORT

Remission of Diabetes Mellitus in Two Patients with Maturity-Onset Diabetes of the Young After Bariatric Surgery
“Maturity-Onset Diabetes of the Young” Tanılı İki Hastada Bariyatrik Cerrahi Sonrasında Diabetes Mellitusun Remisyonu
Received Date : 20 Feb 2021
Accepted Date : 16 Apr 2021
Available Online : 08 Jun 2021
Doi: 10.25179/tjem.2021-82457 - Makale Dili: EN
Turk J Endocrinol Metab. 2021;25:249-254
Bu makale, CC BY-NC-SA altında lisanslanmış açık erişim bir makaledir.
ABSTRACT
We present two cases with “Maturity-onset diabetes of the young” (MODY) undergoing bariatric surgery. Case 1: a 19-year-old woman using intensive insulin for type 1 diabetes mellitus (DM) was diagnosed with obesity. Body mass index (BMI) was 39.17 kg/m2, fasting blood glucose (FBG) was 199 mg/dL, postprandial blood glucose (PPBG) was 239 mg/dL, glycated hemoglobin (HbA1c) was 11.1%, Cpeptide (Cp) was 1.53 ng/mL, and antiGAD and ICA (islet cell autoantibody) were negative. Genetic analysis revealed a heterozygous mutation in HNF1A (MODY 3). We performed Roux-n-Y gastric bypass (RYGB). She discontinued insulin. Case 2: A 33-year-old woman using intensive insulin because of type 2 DM was diagnosed with obesity. BMI was 44.4 kg/m2. FBG was 195 mg/dL, PPBG was 269 mg/dL, HbA1c was 9.4%, Cp was 1.89 ng/mL, and ICA and AntiGAD were negative. Genetic analysis revealed heterozygous mutation in KCNJ11 (MODY 13). RYGB was performed with an indication of morbid obesity. She discontinued insulin. RYGB was performed first in our cases for MODY. Improvement in glycemic regulation was higher than expected. A decision on bariatric surgery in patients with MODY should be made on the basis of the degree of obesity and glycemic status.
ÖZET
(MODY) tanılı 2 olguyu sunuyoruz. Olgu 1: Tip 1 diabetes mellitus (DM) tanısıyla intensif insülin kullanan 19 yaşında kadın hastaya obezite tanısı koyuldu. Beden kitle indeksi (BKİ): 39,17 kg/m2, açlık kan şekeri (AKŞ): 199 mg/dL, tokluk kan şekeri (TKŞ): 239 mg/dL, HbA1c: %11,1, C-peptid (Cp): 1,53 ng/mL, AntiGAD ve adacık hücre otoantikoru [islet cell autoantibody (ICA)] negatif saptandı. Genetik analizde HNF1A geninde heterozigot mutasyon saptandı (MODY 3). Roux-n-Y gastrik bypass (RYGB) uygulandı. Hasta insülin kullanımını bıraktı. Olgu 2: Tip 2 DM nedeniyle intensif insülin kullanan 33 yaşında kadın hastaya obezite tanısı koyuldu. BKİ: 44,4 kg/m2, AKŞ: 195 mg/dL, TKŞ: 269 mg/dL, HbA1c: %9,4, Cp: 1,89 ng/mL, ICA ve AntiGAD negatif saptandı. Genetik analizde KCNJ11 geninde heterozigot mutasyon saptandı (MODY13). Morbid obezite endikasyonuyla RYGB uygulandı. Hasta insülin kullanımını bıraktı. Olgularımız, MODY’de RYGB uygulanan ilk olgulardır. Hastalarımızda glisemik regülasyondaki iyileşme beklediğimizden daha fazlaydı. MODY tanılı hastalarda, bariyatrik cerrahi kararı verilirken obezite derecesi ve glisemik durum birlikte değerlendirilmelidir.
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