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Current Diabetes Reports
Published in: Current Diabetes Reports 4/2016

01-04-2016 | Hospital Management of Diabetes (GE Umpierrez, Section Editor)

Perioperative Glycemic Management of Patients Undergoing Bariatric Surgery

Authors: David Rometo, Mary Korytkowski

Published in: Current Diabetes Reports | Issue 4/2016

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Abstract

Bariatric surgery in patients with type 2 diabetes has been shown to improve glycemic control and reduce need for glucose-lowering medications. Some of these improvements occur in the early postoperative period prior to any weight loss. These early reductions in circulating glucose can be attributed to primarily perioperative caloric restriction and prolonged fasting. Inpatient glycemic targets for patients undergoing bariatric surgery are similar to those recommended for other surgical procedures as a way of minimizing risk for complications. There is evidence that achieving perioperative and postoperative glycemic targets can improve the ability to achieve remission of type 2 diabetes following gastric bypass surgery. This review provides recommendations regarding glycemic goals, strategies for achieving these goals with minimal risk for hypoglycemia, and an examination of the data suggesting an association between perioperative glycemic management and diabetes remission following bariatric surgery.
Literature
1.
Snel M, Jonker JT, Schoones J, et al. Ectopic fat and insulin resistance: pathophysiology and effect of diet and lifestyle interventions. Int J Endocrinol. 2012;2012:983814.CrossRefPubMedPubMedCentral
2.•
Mechanick JI, Youdim A, Jones DB, et al. Clinical practice guidelines for the perioperative nutritional, metabolic, and nonsurgical support of the bariatric surgery patient—2013 update: cosponsored by American Association of Clinical Endocrinologists, The Obesity Society, and American Society for Metabolic & Bariatric Surgery. Obesity. 2013;21 Suppl 1:S1–27. These guidelines provide a level of evidence-based recommendations, including perioperative diabetes management, agreed upon by three leading international societies.CrossRefPubMedPubMedCentral
3.
Ardestani A, Rhoads D, Tavakkoli A. Insulin cessation and diabetes remission after bariatric surgery in adults with insulin-treated type 2 diabetes. Diabetes Care. 2015;38:659–64.PubMed
4.••
Perna M, Romagnuolo J, Morgan K, et al. Preoperative hemoglobin A1c and postoperative glucose control in outcomes after gastric bypass for obesity. Surg Obes Relat Dis. 2012;8:685–90. This analysis demonstrates the association between pre-op glycemic control, hospital hyperglycemia, and postoperative complications in bariatric surgery patients.CrossRefPubMed
5.
Scheen AJ, Letiexhe M, Rorive M, et al. Bariatric surgery: 10-year results of the Swedish Obese Subjects Study. Rev Med Liege. 2005;60:121–5.PubMed
6.
Arterburn DE, Bogart A, Sherwood NE, et al. A multisite study of long-term remission and relapse of type 2 diabetes mellitus following gastric bypass. Obes Surg. 2013;23:93–102.CrossRefPubMedPubMedCentral
7.
Mingrone G, Panunzi S, De Gaetano A, et al. Bariatric surgery versus conventional medical therapy for type 2 diabetes. N Engl J Med. 2012;366:1577–85.CrossRefPubMed
8.
Courcoulas AP, Belle SH, Neiberg RH, et al. Three-year outcomes of bariatric surgery vs lifestyle intervention for type 2 diabetes mellitus treatment: a randomized clinical trial. JAMA Surg. 2015;150:931–40.CrossRefPubMed
9.
Pories WJ, Swanson MS, MacDonald KG, et al. Who would have thought it? An operation proves to be the most effective therapy for adult-onset diabetes mellitus. Ann Surg. 1995;222:339–50. discussion 50-2.CrossRefPubMedPubMedCentral
10.
Pories WJ, Caro JF, Flickinger EG, et al. The control of diabetes mellitus (NIDDM) in the morbidly obese with the Greenville Gastric Bypass. Ann Surg. 1987;206:316–23.CrossRefPubMedPubMedCentral
11.••
Kwon S, Thompson R, Dellinger P, et al. Importance of perioperative glycemic control in general surgery: a report from the Surgical Care and Outcomes Assessment Program. Ann Surg. 2013;257:8–14. This large multicenter study quantifies the associated effects of inpatient hyperglycemia after bariatric surgery and demonstrates the amelioration of those effects when patients receive insulin treatment in the hospital.CrossRefPubMedPubMedCentral
12.
Queale WS, Seidler AJ, Brancati FL. Glycemic control and sliding scale insulin use in medical inpatients with diabetes mellitus. Arch Intern Med. 1997;157:545–52.CrossRefPubMed
13.
Frisch A, Chandra P, Smiley D, et al. Prevalence and clinical outcome of hyperglycemia in the perioperative period in noncardiac surgery. Diabetes Care. 2010;33:1783–8.CrossRefPubMedPubMedCentral
14.
Umpierrez GE, Smiley D, Jacobs S, et al. Randomized Study of Basal-Bolus Insulin Therapy in the Inpatient Management of Patients With Type 2 Diabetes Undergoing General Surgery (RABBIT 2 Surgery). Diabetes Care. 2011;34:256–61.CrossRefPubMedPubMedCentral
15.
Letourneau J, Bui H, Schricker T, et al. HbA1c: a prognostic biomarker in the surgical and critically ill patient population. J Cardiothorac Vasc Anesth. 2013;27:760–4.CrossRefPubMed
16.••
Chuah LL, Miras AD, Papamargaritis D, et al. Impact of perioperative management of glycemia in severely obese diabetic patients undergoing gastric bypass surgery. Surg Obes Relat Dis. 2015;11:578–84. The first and only RCT studying the effect of attempting pre- and postoperative glycemic control on short-term and 1-year outcomes. The study is small with confounders but demonstrates that many questions remain unanswered and will require larger well-designed trials comparing interventions to current standard practices.CrossRefPubMed
17.
Moghissi ES, Korytkowski MT, DiNardo M, et al. American Association of Clinical Endocrinologists and American Diabetes Association consensus statement on inpatient glycemic control. Endocr Pract. 2009;15:353–69.CrossRefPubMed
18.
Umpierrez GE, Hellman R, Korytkowski MT, et al. Management of hyperglycemia in hospitalized patients in non-critical care setting: an endocrine society clinical practice guideline. J Clin Endocrinol Metabol. 2012;97:16–38.CrossRef
19.
DiNardo M, Donihi AC, Forte P, et al. Standardized glycemic management and perioperative glycemic outcomes in patients with diabetes mellitus who undergo same-day surgery. Endocr Pract. 2011;17:404.CrossRefPubMed
20.
Rubin DJ, Rybin D, Doros G, et al. Weight-based, insulin dose-related hypoglycemia in hospitalized patients with diabetes. Diabetes Care. 2011;34:1723–8.CrossRefPubMedPubMedCentral
21.
Datta S, Qaadir A, Villanueva G, et al. Once-daily insulin glargine versus 6-hour sliding scale regular insulin for control of hyperglycemia after a bariatric surgical procedure: a randomized clinical trial. Endocr Pract. 2007;13:225–31.CrossRefPubMed
22.
Heinemann L, Linkeschova R, Rave K, et al. Time-action profile of the long-acting insulin analog insulin glargine (HOE901) in comparison with those of NPH insulin and placebo. Diabetes Care. 2000;23:644–9.CrossRefPubMed
23.
Plank J, Bodenlenz M, Sinner F, et al. A double-blind, randomized, dose-response study investigating the pharmacodynamic and pharmacokinetic properties of the long-acting insulin analog detemir. Diabetes Care. 2005;28:1107–12.CrossRefPubMed
24.
Sobel SI, Augustine M, Donihi AC, et al. Safety and efficacy of a peri-operative protocol for patients with diabetes treated with continuous subcutaneous insulin infusion who are admitted to same day surgery. Endocr Pract. 2015;21(11):1269–76.
25.
Akhtar S, Barash PG, Inzucchi SE. Scientific principles and clinical implications of perioperative glucose regulation and control. Anesth Analg. 2010;110:478–97.CrossRefPubMed
26.
Joshi GP, Chung F, Vann MA, et al. Society for Ambulatory Anesthesia consensus statement on perioperative blood glucose management in diabetic patients undergoing ambulatory surgery. Anesth Analg. 2010;111:1378–87.CrossRefPubMed
27.
Lowery JB, Donihi AC, Korytkowski MT. U-500 insulin as a component of basal bolus insulin therapy in type 2 diabetes. Diabetes Technol Ther. 2012;14:505–7.CrossRefPubMedPubMedCentral
28.
Standards of medical care in diabetes—2015: summary of revisions. Diabetes Care. 2015;38 Suppl:S4.
29.••
Fenske WK, Pournaras DJ, Aasheim ET, et al. Can a protocol for glycaemic control improve type 2 diabetes outcomes after gastric bypass? Obes Surg. 2012;22:90–6. This is the first study that evaluated the effect of a postoperative glycemic control intervention on diabetes remission rate. This study opens the door to the concept of adjuvant therapy for diabetes remission. Further studies to determine the best glycemic targets and medication/diet regimens to maximize postoperative diabetes remission rate and duration can be justified based on its clear and optimistic findings.CrossRefPubMed
30.
Schauer PR, Bhatt DL, Kirwan JP, et al. Bariatric surgery versus intensive medical therapy for diabetes—3-year outcomes. New Engl J Med. 2014;370:2002–13.CrossRefPubMed
31.
Schauer PR, Kashyap SR, Wolski K, et al. Bariatric surgery versus intensive medical therapy in obese patients with diabetes. New Engl J Med. 2012;366:1567–76.CrossRefPubMedPubMedCentral
32.
Van Nieuwenhove Y, Dambrauskas Z, Campillo-Soto A, et al. Preoperative very low-calorie diet and operative outcome after laparoscopic gastric bypass: a randomized multicenter study. Arch Surg. 2011;146:1300–5.CrossRefPubMed
33.
Moize VL, Pi-Sunyer X, Mochari H, et al. Nutritional pyramid for post-gastric bypass patients. Obes Surg. 2010;20:1133–41.CrossRefPubMed
34.
Parkes E. Nutritional management of patients after bariatric surgery. Am J Med Sci. 2006;331:207–13.CrossRefPubMed
35.
Sarwer DB, Wadden TA, Moore RH, et al. Preoperative eating behavior, postoperative dietary adherence, and weight loss after gastric bypass surgery. Surg Obes Relat Dis. 2008;4:640–6.CrossRefPubMedPubMedCentral
36.••
Jackness C, Karmally W, Febres G, et al. Very low-calorie diet mimics the early beneficial effect of Roux-en-Y gastric bypass on insulin sensitivity and β-cell function in type 2 diabetic patients. Diabetes. 2013;62:3027–32. Demonstrating that short-term glycemic and metabolic improvements after gastric bypass can be attributed to diet change alone, this paper reverses the early-held belief that the physiology of the surgical procedure itself was an instant surgical cure for many patients with T2D.CrossRefPubMedPubMedCentral
37.
Lingvay I, Guth E, Islam A, et al. Rapid improvement in diabetes after gastric bypass surgery: is it the diet or surgery? Diabetes Care. 2013;36:2741–7.CrossRefPubMedPubMedCentral
38.
Plourde CE, Grenier-Larouche T, Caron-Dorval D, et al. Biliopancreatic diversion with duodenal switch improves insulin sensitivity and secretion through caloric restriction. Obesity. 2014;22:1838–46.CrossRefPubMed
39.
Lim EL, Hollingsworth KG, Aribisala BS, et al. Reversal of type 2 diabetes: normalisation of beta cell function in association with decreased pancreas and liver triacylglycerol. Diabetologia. 2011;54:2506.CrossRefPubMedPubMedCentral
40.
Laferrère B, Teixeira J, McGinty J, et al. Effect of weight loss by gastric bypass surgery versus hypocaloric diet on glucose and incretin levels in patients with type 2 diabetes. J Clin Endocrinol Metabol. 2008;93(7):2479–85.CrossRef
41.
Vetter ML, Wadden TA, Teff KL, et al. GLP-1 plays a limited role in improved glycemia shortly after Roux-en-Y gastric bypass: a comparison with intensive lifestyle modification. Diabetes. 2015;64(2):434–46.CrossRefPubMedPubMedCentral
42.
Wing RR, Blair EH, Bononi P, et al. Caloric restriction per se is a significant factor in improvements in glycemic control and insulin sensitivity during weight loss in obese NIDDM patients. Diabetes Care. 1994;17(1):30–6.CrossRefPubMed
43.
Argyropoulos G. Bariatric surgery: prevalence, predictors, and mechanisms of diabetes remission. Curr Diab Rep. 2015;15(4):15.CrossRefPubMed
Metadata
Title
Perioperative Glycemic Management of Patients Undergoing Bariatric Surgery
Authors
David Rometo
Mary Korytkowski
Publication date
01-04-2016
Publisher
Springer US
Published in
Current Diabetes Reports / Issue 4/2016
Print ISSN: 1534-4827
Electronic ISSN: 1539-0829
DOI
https://doi.org/10.1007/s11892-016-0718-6

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Diabetes and Pregnancy (CJ Homko, Section Editor)

Bariatric Surgery and the Pregnancy Complicated by Gestational Diabetes

Hospital Management of Diabetes (GE Umpierrez, Section Editor)

Intensive Glycemic Control in Cardiac Surgery

Diabetes and Pregnancy (CJ Homko, Section Editor)

Role of Medical Nutrition Therapy in the Management of Gestational Diabetes Mellitus

Other Forms of Diabetes (JJ Nolan, Section Editor)

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WHO estimates that half of all patients worldwide are non-adherent to their prescribed medication. The consequences of poor adherence can be catastrophic, on both the individual and population level.

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