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

Chuah, Ling Ling; Miras, Alexander D.; Papamargaritis, Dimitris; Jackson, Sabina N; Olbers, Torsten; Roux, Carel W. le

doi:10.1016/j.soard.2014.11.004

Cited by 18 publications

(22 citation statements)

References 16 publications

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“…Preoperative and postoperative intensive diabetes management was compared to conservative treatment in RYGB patients . Patients were enrolled in two separate trials, the GLUCOSURG‐pre and GLUCOSURG‐post, to evaluate 1‐year outcomes of intensive versus conservative management preoperatively and postoperatively.…”

Section: Resultsmentioning

confidence: 99%

“…In both trials there were limited hypoglycemic episodes in the intensive groups, none of which were symptomatic. Authors concluded that intensive versus conservative glucose management was feasible but did not result in significant 12‐month postoperative outcomes …”

Section: Resultsmentioning

confidence: 99%

“…Additionally, patients started on a diabetes management protocol targeting FBG levels of 90–145 mg/dl with continued titration after hospital discharge were more likely to achieve A1C levels < 7% and were more likely to achieve complete remission of T2DM at 1 year compared with patients not managed on a protocol . Contrary to this evidence, the GLUCOSURG‐post trial was unable to show any difference in 1‐year outcomes with 2 weeks of intensive versus conservative insulin management postoperatively . Unfortunately, each of these three trials utilized different protocols and different blood glucose goals for insulin titration; however, in general each used some form of SSI with or without LA insulin.…”

Section: Discussionmentioning

confidence: 95%

“…In the studies reviewed, most followed strict perioperative monitoring strategies to identify and address PBH . In one study of closely monitored patients in the perioperative period, hypoglycemia incidence did not differ between strict control with LA insulin versus SSI .…”

Section: Discussionmentioning

confidence: 99%

“…Additionally, an immediate perioperative regimen of a 75% reduction in preoperative mealtime insulin or 1/12 of TDD insulin in another trial yielded no episodes of hypoglycemia . Trials evaluating postoperative insulin management and long‐term outcomes also did not identify any significant difference in hypoglycemia between patients either optimally controlled or on protocols and those who were not . With the exception of one, all trials evaluated included SSI with close monitoring …”

Section: Discussionmentioning

confidence: 99%

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Glycemic Management in the Bariatric Surgery Population: A Review of the Literature

2018

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Obesity is a worldwide epidemic often complicated by multiple comorbidities, including type 2 diabetes mellitus (T2DM). Bariatric surgery is an increasingly common and effective weight-loss strategy for obese patients that may result in resolution of metabolic-related disease states, such as T2DM. Although bariatric surgery has many positive outcomes for patients, dietary and pathophysiologic changes can create difficult-to-control blood glucose, especially in the immediate perioperative setting. Depending on oral antidiabetic agent and insulin needs preoperatively, many patients require cessation of oral agents and reduction or cessation of insulin. Unfortunately, despite available perioperative bariatric surgery guidelines, no specific recommendations for perioperative oral antidiabetic agent or insulin management exist. The purpose of this article is to review the current body of evidence for blood glucose management in the setting of bariatric surgery. An English-language PubMed and MEDLINE search was conducted from 1964 through March 2018 using the following search terms alone and in various combinations: bariatric surgery, gastric banding, laparoscopic sleeve gastrectomy (LSG), Roux-en-Y gastric bypass (RYGB), glucose management, insulin, and oral antidiabetic agent. Five articles were identified evaluating insulin management in the perioperative bariatric surgery setting, which were separated into two categories: immediate perioperative insulin management and long-term postoperative insulin management. Overall, various blood glucose management insulin protocols were evaluated. All studies included some type of insulin reduction in the perioperative setting. No studies identified specifically evaluated down-titration or discontinuation of oral antidiabetic agents. Given the lack of specific guideline recommendations, limitations of standardized insulin protocols, and inconsistency of outcomes studied, perioperative insulin at reduced doses compared to previous maintenance doses coupled with frequent blood glucose monitoring is reasonable. An opportunity exists for successful protocols to be addressed in future, larger studies.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 95%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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