Management of type 2 diabetes before and after bariatric surgery requires the following:
Recent ophthalmoscopy and cardiac ultrasound before surgery
Monitoring of glucose capillary levels in the immediate postoperative period
Adjustment of insulin treatment made by diabetologist
Use of metformin and DPP-4 inhibitors if a non-insulin glucose lowering treatment is required
HbA1c tested every 6 months even in case of diabetes remission
Metabolic surgery is now considered as a therapeutic option in type 2 diabetes (T2D). However, few data are available regarding perioperative management of T2D.
To assess current practice among bariatric teams regarding perioperative management of T2D in order to propose guidelines.
A two-round Delphi method using online surveys was employed among bariatric teams experts (surgeons, diabetologists, anesthetists, nutritionists): first round, 63 questions covering 6 topics (characteristics of experts/teams, characteristics of patients, operative technique, pre/postoperative management, diabetes remission); second round, 44 items needing clarification. They were discussed within national congress of corresponding learned societies. Consensus was defined as ≥66% agreement.
A total of 170 experts participated. Experts favored gastric bypass to achieve remission (76.7%). Screening for retinopathy, cardiac ultrasound, and reaching an HbA1c<8% are required in the pre-operative period for 67%, 75.3% and 56.7% of experts, respectively. After surgery, insulin pump should not be stopped, basal insulin should be halved, and bolus insulin should be stopped except if severe hyperglycemia. DPP-IV inhibitors and metformin are preferred after surgery. Patients should be seen by a diabetologist within one month if on oral antidiabetic agents (71.8% of experts), 2 weeks if on injectable treatments (77.1% of experts), and immediately after surgery if on insulin pump (93.5% of experts). Long-term monitoring of HbA1c is necessary even if diabetes remission (100%).
Rapid postoperative modifications of blood glucose require a close monitoring and a prompt adjustment of diabetes medications.El texto completo de este artículo está disponible en PDF.
Keywords : Metabolic surgery, Diabetes, Guidelines, Bariatric surgery
Vol 157 - N° 1P. 13-21 - février 2020 Regresar al número
Bienvenido a EM-consulte, la referencia de los profesionales de la salud.
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