Remission of Diabetes Mellitus in Two Patients withMaturity-Onset Diabetes ofthe Young After Bariatric Surgery

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 diagno-sed with obesity. Body mass index (BMI) was 39.17 kg/m2, fastingblood glucose (FBG) was 199 mg/dL, postprandial blood glucose (PPBG) was 239 mg/dL, glycated hemoglobin (HbA1c) was 11.1%, C-peptide (Cp) was 1.53 ng/mL, and antiGAD and ICA (islet cell auto-antibody) 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 statu

Bariyatrik cerrahi uygulanan “Maturity-onset diabetes of the young”(MODY) tanılı 2 olguyu sunuyoruz. Olgu 1: Tip 1 diabetes mellitus(DM) tanısıyla intensif insülin kullanan 19 yaşında kadın hastaya obe- zite tanısı koyuldu. Beden kitle indeksi (BKİ): 39,17 kg/m2, açlık kanşekeri (AKŞ): 199 mg/dL, tokluk kan şekeri (TKŞ): 239 mg/dL,HbA1c: %11,1, C-peptid (Cp): 1,53 ng/mL, AntiGAD ve adacık hücreotoantikoru [islet cell autoantibody (ICA)] negatif saptandı. Genetikanalizde HNF1A geninde heterozigot mutasyon saptandı (MODY 3).Roux-n-Y gastrik bypass (RYGB) uygulandı. Hasta insülin kullanımınıbıraktı. Olgu 2: Tip 2 DM nedeniyle intensif insülin kullanan 33 ya- şında 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 veAntiGAD negatif saptandı. Genetik analizde KCNJ11 geninde hetero- zigot mutasyon saptandı (MODY13). Morbid obezite endikasyonuylaRYGB uygulandı. Hasta insülin kullanımını b ıraktı. Olgularımız,MODY’de RYGB uygulanan ilk olgulardır. Hastalarımızda glisemik re- gülasyondaki iyileşme beklediğimizden daha fazlaydı. MODY tanılıhastalarda, bariyatrik cerrahi kararı verilirken obezite derecesi ve gli- semik durum birlikte değerlendirilmelidir