Can a Protocol for Glycaemic Control Improve Type 2 Diabetes Outcomes After Gastric Bypass?

Abstract

The protocol-driven management proved to be feasible, safe and effective in achieving targeted glycaemic control in T2DM after RYGB. The next step will be to scrutinise the efficacy of protocol-driven management in a randomised controlled clinical trial.

Impact of perioperative management of glycemia in severely obese diabetic patients undergoing gastric bypass surgery

“…Scopinaro et al reported that in patients with BMI o30 kg/m 2 and poorly controlled T2 DM, perioperative insulin improved HbA1 c 1 year after biliopancreatic diversion [8]. We found that intensive perioperative glycemic management after RYGB also resulted in better HbA1 c at 1 year [9]. As these were both cohort studies, a randomised controlled trial was required to exclude allocation bias.…”

“…After surgery, patients emailed or texted the metabolic physician with their fasting CG readings daily. Insulin doses were titrated using a validated insulin titration protocol [9]. The daily contact was discontinued once glucose readings were within target for at least 3 consecutive days.…”

Clinical Management of Type 2 Diabetes Mellitus after Bariatric Surgery

“…However, there is evidence to suggest that personalized insulin titration, in combination with oral hypoglycemic agents, confers significant glycemic benefit to patients following RYGB. Specifically, obese patients with insulinrequiring T2DM after RYGB showed higher rates of complete remission at 1 year post-surgery with personalized insulin titration schedules and metformin compared to patients whose post-surgical care did not involve protocoldriven pharmacological treatment [51]. While these findings have yet to be confirmed on a larger-scale, they do indicate that combinations of existing T2DM therapeutics can provide adequate glycemic control following bariatric surgery.…”

Where to Begin and Where to End? Preoperative Assessment for Patients Undergoing Metabolic Surgery

“…More recent randomized controlled clinical trials indicate that metabolic surgery controls glycemia more effectively than medical care [42,43]. Nevertheless, very few published algorithms for the management of glycemia immediately before and after surgery exist [44]. …”