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Health Outcomes of a 58-Year-Old Man With Type 2 Diabetes Who Had Roux-en-Y Gastric Bypass

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	Presentation

 
J.M. is a 58-year-old man with a history of type 2 diabetes since 1996. He has struggled with his weight throughout most of his life, with his highest adult weight at 407 lb. In March 1998, J.M. enrolled in a phone-based counseling service with a registered dietitian (RD) offered through his managed care organization. The phone program is voluntary and consists of regular phone calls, usually every 2-4 weeks, to discuss diabetes and weight management.

J.M.'s height and weight on initial assessment were 69" and 335 lb. (BMI = 49.5 kg/m²). His hemoglobin A_1c (A1C) was 5.4% on extended-release glipizide, 5 mg twice daily. His blood pressure was 144/78 mmHg, and his lipid panel revealed a total cholesterol of 220 mg/dl and an HDL cholesterol of 52 mg/dl. LDL cholesterol and triglycerides were not separately measured at that time. In addition to the diabetes medication, J.M. was also taking hydrochlorothiazide, 25 mg/day, and lisinopril, 10 mg/day, to manage hypertension.

Throughout the 3 years that J.M. participated in the phone program, he underwent several medical setbacks, including diagnoses of hypercholesterolemia and myasthenia gravis, a neuromuscular disorder characterized by muscle weakness and fatigue. The myasthenia gravis limited his ability to exercise regularly and caused symptoms such as diplopia, difficulty chewing and swallowing, and extensive fatigue. Months later, J.M. discovered a tumor growth, which was removed successfully in 2001. However, detection of the tumor caused him to lose motivation. He struggled with setting lifestyle goals, especially regarding nutrition, because he felt he could not make a significant impact on his health. Consequently, J.M.'s weight continued to escalate and reached 350 lb. Several medications were added during these years to manage his increasingly poor health.

In September 2001, J.M.'s internal medicine physician encouraged him to seek surgical treatment for obesity. The provider believed . . . [Full Text of this Article]

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