The number of patients undergoing bariatric surgery for morbid obesity is increasing. Type 2 diabetes is common among patients undergoing bariatric surgery. The effect of bariatric surgery on glycemia is profound in patients with diabetes and might vary between different bariatric surgical procedures. Therefore, almost invariably, there is a need to adjust antidiabetic drug dosages in the postoperative period in order to prevent hypoglycemia.
Moreover, preoperatively, very low calorie diet protocols are applied in many centers to facilitate surgery by reducing liver volume. Because low caloric intake will increase insulin sensitivity, there is also a need for dose adjustments of glucose-lowering drugs during this period as well. Guidelines for adjustments of antidiabetic treatment before and after bariatric surgery are scarce. In this article, an overview of different bariatric surgical procedures as well as their effects on diabetes are presented. Recommendations on the perioperative antidiabetic treatment are proposed.
PreisSRHwangSJCoadySPencinaMJD'AgostinoRBSrSavagePJLevyDFoxCS.Trends in all-cause and cardiovascular disease mortality among women and men with and without diabetes mellitus in the Framingham Heart Study, 1950 to 2005. Circulation. 2009; 119 (13): 1728–35. Epub 2009 Mar 23.
2.
HuFB.Obesity and mortality: watch your waist, not just your weight. Arch Intern Med. 2007; 167 (9): 875–6.
3.
Prospective Studies Collaboration, WhitlockGLewingtonSSherlikerPClarkeREmbersonJHalseyJQizilbashNCollinsRPetoR.Body-mass index and cause-specific mortality in 900 000 adults: collaborative analyses of 57 prospective studies. Lancet. 2009; 373 (9669): 1083–96. Epub 2009 Mar 18.
4.
SjöströmLNarbroKSjöströmCDKarasonKLarssonBWedelHLystigTSullivanMBouchardCCarlssonBBengtssonCDahlgrenSGummessonAJacobsonPKarlssonJLindroosAKLönrothHNäslundIOlbersTStenlöfKTorgersonJAgrenGCarlssonLM; Swedish Obese Subjects Study. Effects of bariatric surgery on mortality in Swedish obese subjects. N Engl J Med. 2007; 357 (8): 741–52.
5.
GreenwaySEGreenwayFL3rdKleinS. Effects of obesity surgery on non-insulin-dependent diabetes mellitus. Arch Surg. 2002; 137 (10): 1109–17.
6.
SjöströmLLindroosAKPeltonenMTorgersonJBouchardCCarlssonBDahlgrenSLarssonBNarbroKSjöströmCDSullivanMWedelH; Swedish Obese Subjects Study Scientific Group. Lifestyle, diabetes, and cardiovascular risk factors 10 years after bariatric surgery. N Engl J Med. 2004; 351 (26): 2683–93.
7.
ReisCEAlvarez-LeiteJIBressanJAlfenasRC.Role of bariatric-metabolic surgery in the treatment of obese type 2 diabetes with body mass index <35 kg/m2: a literature review. Diabetes Technol Ther. 2012; 14 (4): 365–72. Epub 2011 Dec 16.
8.
ThorellA.Clinical Nutrition University: Nutritional support after bariatric surgery. e-SPEN, the European e-Journal of Clinical Nutrition and Metabolism6 (2011) e96–e100.
9.
RubinoFGagnerMGentileschiPKiniSFukuyamaSFengJDiamondE.The early effect of the Roux-en-Y gastric bypass on hormones involved in body weight regulation and glucose metabolism. Ann Surg. 2004; 240 (2): 236–42.
10.
BuchwaldHOienDM.Metabolic/bariatric surgery Worldwide 2008. Obes Surg. 2009; 19 (12): 1605–11.
11.
FrezzaEEChiriva-InternatiMWachtelMS.Analysis of the results of sleeve gastrectomy for morbid obesity and the role of ghrelin. Surg Today. 2008; 38 (6): 481–3. Epub 2008 May 31.
12.
ScopinaroN.Thirty-five years of biliopancreatic diversion: notes on gastrointestinal physiology to complete the published information useful for a better understanding and clinical use of the operation. Obes Surg. 2012; 22 (3): 427–32.
13.
OlbersTBjörkmanSLindroosAMaleckasALönnLSjöströmLLönrothH.Body composition, dietary intake, and energy expenditure after laparoscopic Roux-en-Y gastric bypass and laparoscopic vertical banded gastroplasty: a randomized clinical trial. Ann Surg. 2006; 244 (5): 715–22.
14.
BueterMLöwensteinCOlbersTWangMClunyNLBloomSRSharkeyKALutzTAle RouxCW. Gastric bypass increases energy expenditure in rats. Gastroenterology. 2010; 138 (5): 1845–53. Epub 2009 Nov 18.
15.
LimELHollingsworthKGAribisalaBSChenMJMathersJCTaylorR.Reversal of type 2 diabetes: normalisation of beta cell function in association with decreased pancreas and liver triacylglycerol. Diabetologia. 2011; 54 (10): 2506–14. Epub 2011 Jun 9.
16.
RubinoFGagnerM.Potential of surgery for curing type 2 diabetes mellitus. Ann Surg. 2002; 236 (5): 554–9.
17.
DixonJBBhathalPSO'BrienPE.Nonalcoholic fatty liver disease: predictors of nonalcoholic steatohepatitis and liver fibrosis in the severely obese. Gastroenterology. 2001; 121 (1): 91–100.
18.
CollesSLDixonJBMarksPStraussBJO'BrienPE.Preoperative weight loss with a very-low-energy diet: quantitation of changes in liver and abdominal fat by serial imaging. Am J Clin Nutr. 2006; 84 (2): 304–11.
19.
Van NieuwenhoveYDambrauskasZCampillo-SotoAvan DielenFWiezerRJanssenIKramerMThorellA.Preoperative very low-calorie diet and operative outcome after laparoscopic gastric bypass: a randomized multicenter study. Arch Surg. 2011; 146 (11): 1300–5.
20.
BenottiPNStillCDWoodGCAkmalYKingHEl ArousyHDanceaHGerhardGSPetrickAStrodelW.Preoperative weight loss before bariatric surgery. Arch Surg. 2009; 144 (12): 1150–5.
21.
MechanickJIKushnerRFSugermanHJGonzalez-CampoyJMCollazo-ClavellMLSpitzAFApovianCMLivingstonEHBrolinRSarwerDBAndersonWADixonJGuvenS; American Association of Clinical Endocrinologists; Obesity Society; American Society for Metabolic & Bariatric Surgery. American Association of Clinical Endocrinologists, The Obesity Society, and American Society for Metabolic & Bariatric Surgery medical guidelines for clinical practice for the perioperative nutritional, metabolic, and nonsurgical support of the bariatric surgery patient. Obesity (Silver Spring). 2009; 17Suppl 1: S1–70, v.
22.
PernaMRomagnuoloJMorganKByrneTKBakerM.Preoperative hemoglobin A1c and postoperative glucose control in outcomes after gastric bypass for obesity. Surg Obes Relat Dis. 2011. [Epub ahead of print].
