| Yoon Pyo Lee | 2 Articles |
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[English]
Gestational diabetes mellitus (GDM) affects 2%-4% of the all pregnant women, and it is a major risk factor for development of type 2 DM. We performed this cross-sectional study to determine whether there were defects in insulin secretory capacity or insulin sensitivity in women with previous GDM. On 6-8 weeks after delivery, 75 g oral glucose tolerance test was performed in 36 women with previous GDM and 19 non-pregnant control women matched with age and weight. Intravenous glucose tolerance test was performed on 10-14 weeks after delivery. Insulin secretory capacity measured as the acute insulin response to glucose (AIRg) and insulin sensitivity as minimal model derived sensitivity index (SI) were obtained. AIRg×SI (β-cell disposition index) was used as an index of β-cell function. Women with previous GDM were classified into normal glucose tolerance (postpartum-NGT, n=19) and impaired glucose tolerance (postpartum-IGT, n=17). Postpartum fasting glucose levels were significantly higher in postpartum-IGT compared to postpartum-NGT and control (P<0.05). AIRg×SI was significantly lower in postpartum-IGT compared to control (P<0.05). SI was lower in postpartum-NGT and postpartum-IGT compared to control, but the difference did not have the statistical significance. Frequency of parental history of type 2 diabetes was significantly greater in postpartum-IGT compared to postpartum-NGT (P<0.05). Women with previous GDM showed impaired insulin secretion although their glucose tolerance states were restored to normal. It suggests impaired early insulin secretion may be a major pathophysiologic factor for development of type 2 DM, and this defect may be genetically determined.
[English]
Laparoscopic sleeve gastrectomy can reduce morbidity and mortality in patients with morbid obesity, but it can cause complications such as a gastrointestinal leak. A 30-year-old morbidly obese female who had type 2 diabetes mellitus and hypertension with estimated body mass index of 40.2 kg/m2 was admitted. Laparoscopic sleeve gastrectomy was performed. On postoperative day 19, a leak was suspicious on physical examination and radiologic findings. Conservative management was performed, but the patient was hemodynamically unstable and imminently septic. After laparoscopic drainage procedure, esophagogastroduodenoscopy was performed and revealed the fistula opening at staple line just below gastroesophageal junction. Fibrin tissue adhesive was injected around the fistula and the esophageal covered stent was inserted to cover the leak. At 14th days after stent insertion, the barium study confirmed no more leak. In this case, we experienced that the esophageal stent insertion with fibrin tissue adhesive injection may reduce recovery time of the fistula developed after laparoscopic sleeve gastrectomy.
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, Soo Kyung Lim
