Optimizing Glycemic Control in Bariatric Surgery: Evaluating the Impact of Continuous Glucose Monitoring in the Pre- and Post-Surgical Periods

Obesity is a significant global health challenge, closely associated with metabolic disorders such as type 2 diabetes mellitus (T2D). Bariatric surgery has proven to be an effective intervention for severe obesity, offering substantial weight loss and improved glycemic control, with some patients achieving diabetes remission. However, these procedures can induce complex glycemic dynamics, including increased variability and hypoglycemia, which are inadequately captured by traditional metrics like HbA1c. Continuous glucose monitoring (CGM) has revolutionized glycemic management by providing real-time insights into glucose fluctuations, yet its application in post-bariatric surgery populations remains underexplored. Current CGM studies in this context are limited by small sample sizes, inconsistent methodologies, and a lack of standardized metrics. This study aims to address these gaps by leveraging CGM technology to characterize glycemic patterns before and after bariatric surgery. Specifically, we will assess glycemic variability, fasting glucose levels, and postprandial excursions in patients with obesity and T2D undergoing Roux-en-Y gastric bypass or sleeve gastrectomy. Furthermore, we aim to identify predictive CGM metrics, such as time in range and glycemic variability, for diabetes remission following surgery. Lastly, we will investigate how dietary content, formulation, and eating patterns influence glycemic responses to refine personalized nutritional strategies. By integrating advanced CGM methodologies and standardizing data collection across diverse populations and surgical techniques, this study seeks to enhance our understanding of glycemic responses in bariatric surgery and establish procedure-specific glycemic reference ranges. The findings will inform tailored interventions to optimize long-term outcomes and improve

clinical management in this population.

CBT for Insomnia to Improve Diabetes Outcomes in Louisiana Patients

Insomnia, a common sleep disorder, is strongly linked to type 2 diabetes (T2D) prevalence and poor glycemic control. In Louisiana, which has one of the highest diabetes rates in the U.S., significant disparities exist across race, sex, income, and rural residence. Although sleep is critical in diabetes management, insomnia remains largely unaddressed in care. This pilot randomized controlled trial will evaluate the implementation and effectiveness of cognitive behavioral therapy for insomnia (CBT-I) in federally qualified health centers serving at-risk populations. Thirty adults (aged 40+) with uncontrolled T2D (HbA1c >7%) and comorbid insomnia (Insomnia Severity Index [ISI] score ≥15) will be randomized to 8-week CBT-I or usual care. We will assess the feasibility, acceptability, and fidelity of CBT-I implementation and its effects on sleep (ISI scores, actigraphy) and cardiometabolic outcomes (HbA1c, fasting glucose, insulin) at 3 months. Results will inform strategies to reduce disparities and improve diabetes outcomes in Louisiana.

Role of alpha2 adrenergic receptor antagonism in treating misuse of fentanyl adulterated with xylazine

Adulteration of fentanyl with xylazine is a growing threat that presents a set of health challenges to individuals in Louisiana including difficulty initiating addiction treatment with conventional pharmacotherapies due to differences in the drug pharmacology of fentanyl and xylazine (mu opioid receptor agonism vs. alpha2 adrenergic receptor agonism). In this proposal, we will explore two alpha2 adrenergic receptor antagonists, atipamezole and mirtazapine (FDA approved), as potential pharmacotherapies to treat misuse of fentanyl adulterated with xylazine. Because mirtazapine also acts as a 5-HT1 receptor agonist, we will test selective 5-HT1 receptor agonist, sumatriptan (FDA approved). In Aim 1, we will test the hypothesis that alpha2 adrenergic receptor antagonists attenuate drug reward in rats that receive co-administration of fentanyl and xylazine compared to vehicle controls. This work directly addresses an urgent clinical need of Louisiana residents as it may rapidly identify novel medication strategies to reduce fentanyl misuse.

Outcome of body composition assessment in patients with severe obesity undergoing metabolic surgery

Severe obesity, defined as a BMI of 40 kg/m² or higher1 affects approximately 9.4% of the US population5-6 Metabolic Surgery (MS) is the only proven long-term treatment for this group, who face significantly higher risks of severe comorbidities1-4. Despite its prevalence, there is a significant knowledge gap regarding the most effective tools for assessing body composition in this population. Traditional methods like BMI and waist circumference may not accurately reflect changes, especially in higher BMI patients. This LA CaTS pilot project proposes a non-randomized trial to evaluate the effectiveness of different body composition measurement tools in patients undergoing MS. We will recruit 20 participants with a BMI ≥40, undergoing MS at the Metamor Institute, Pennington Biomedical Research Center. Assessments will utilize both traditional and advanced tools before and 6 months after surgery. The project aims to generate crucial data to support future research funding and the PI's  transition to scientific independence.