2023 Volume 66 Issue 11 Pages 790-796
The patient was a 49-year-old man who had weighed 85 kg at 20 years old, with his weight increasing to a maximum of 160 kg in his 40s. He was diagnosed with glucose intolerance in X-4 during a health checkup. In X-3, he was diagnosed as diabetic with an HbA1c of 8.5 % and started on intensive insulin therapy. The treatment was subsequently changed to dapagliflozin 5 mg/day, metformin 500 mg/day and dulaglutide 0.75 mg/week. The HbA1c value was stable at around 6.0 %, but the patient had hypertension and other complications and was referred to our metabolic surgery clinic in X-1. A preoperative examination revealed a high anti-GAD antibody level of 143 IU/mL (via an enzyme-linked immunosorbent assay) and a diagnosis of slowly progressive insulin-dependent diabetes mellitus (SPIDDM) based on his clinical history. After hospitalization for weight loss, he underwent laparoscopic sleeve gastrectomy (LSG). Nine months after surgery, insulin secretion was still preserved on the glucagon tolerance test, with a ΔCPR of 4.72 ng/mL (previous value: 2.06 ng/mL). This is the first report of LSG in a patient with SPIDDM with a relatively high titer of anti-GAD antibodies and disease duration of <10 years in Japan and is considered a valuable case.
