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Wilmington R, Abuawwad M, Holt G, Anderson R, Aldafas R, Awad S, Idris I. The Effects of Preoperative Glycaemic Control (HbA1c) on Bariatric and Metabolic Surgery Outcomes: Data from a Tertiary-Referral Bariatric Centre in the UK. Obes Surg 2024; 34:850-854. [PMID: 38221566 PMCID: PMC10899277 DOI: 10.1007/s11695-023-06964-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 11/14/2023] [Accepted: 11/14/2023] [Indexed: 01/16/2024]
Abstract
BACKGROUND Current recommendations advocate the achievement of an optimal glucose control (HbA1c < 69 mmol/mol) prior to elective surgery to reduce risks of peri- and post-operative complications, but the relevance for this glycaemic threshold prior to Bariatric Metabolic Surgery (BMS) following a specialist weight management programme remains unclear. METHODS We undertook a retrospective cohort study of patients with type 2 diabetes mellitus (T2DM) who underwent BMS over a 6-year period (2016-2022) at a regional tertiary referral following completion of a specialist multidisciplinary weight management. Post-operative outcomes of interest included 30-day mortality, readmission rates, need for Intensive Care Unit (ICU) care and hospital length of stay (LOS) and were assessed according to HbA1c cut-off values of < 69 (N = 202) and > 69 mmol/mol (N = 67) as well as a continuous variable. RESULTS A total of 269 patients with T2D were included in this study. Patients underwent primary Roux en-Y gastric bypass (RYGB, n = 136), Sleeve Gastrectomy (SG, n = 124), insertion of gastric band (n = 4) or one-anastomosis gastric bypass (OAGB, n = 4). No significant differences in the rates of complications were observed between the two groups of pre-operative HbA1c cut-off values. No HbA1c threshold was observed for glycaemic control that would affect the peri- and post-operative complications following BMS. CONCLUSIONS We observed no associations between pre-operative HbA1C values and the risk of peri- and post-operative complications. In the context of a specialist multidisciplinary weight management programme, optimising pre-operative HbA1C to a recommended target value prior to BMS may not translate into reduced risks of peri- and post-operative complications.
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Affiliation(s)
- Rebekah Wilmington
- Clinical, Metabolic and Molecular Physiology Research Group, MRC-Versus Arthritis Centre for Musculoskeletal Ageing Research, University of Nottingham, Royal Derby Hospital Centre, Uttoxeter Road, Derby, DE22 3NE, UK.
- National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, Nottingham, UK.
- East Midlands Bariatric & Metabolic Institute (EMBMI), Royal Derby Hospital, University Hospitals of Derby & Burton NHS Foundation Trust, Derby, UK.
| | - Mahmoud Abuawwad
- East Midlands Bariatric & Metabolic Institute (EMBMI), Royal Derby Hospital, University Hospitals of Derby & Burton NHS Foundation Trust, Derby, UK
| | - Guy Holt
- East Midlands Bariatric & Metabolic Institute (EMBMI), Royal Derby Hospital, University Hospitals of Derby & Burton NHS Foundation Trust, Derby, UK
| | - Robyn Anderson
- East Midlands Bariatric & Metabolic Institute (EMBMI), Royal Derby Hospital, University Hospitals of Derby & Burton NHS Foundation Trust, Derby, UK
| | - Rami Aldafas
- Clinical, Metabolic and Molecular Physiology Research Group, MRC-Versus Arthritis Centre for Musculoskeletal Ageing Research, University of Nottingham, Royal Derby Hospital Centre, Uttoxeter Road, Derby, DE22 3NE, UK
- National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, Nottingham, UK
- Faculty of Public Health, College of Health Science, The Saudi Electronic University, Riyadh, Saudi Arabia
| | - Sherif Awad
- East Midlands Bariatric & Metabolic Institute (EMBMI), Royal Derby Hospital, University Hospitals of Derby & Burton NHS Foundation Trust, Derby, UK
| | - Iskandar Idris
- Clinical, Metabolic and Molecular Physiology Research Group, MRC-Versus Arthritis Centre for Musculoskeletal Ageing Research, University of Nottingham, Royal Derby Hospital Centre, Uttoxeter Road, Derby, DE22 3NE, UK
- National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, Nottingham, UK
- East Midlands Bariatric & Metabolic Institute (EMBMI), Royal Derby Hospital, University Hospitals of Derby & Burton NHS Foundation Trust, Derby, UK
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Bellon F, Solà I, Gimenez-Perez G, Hernández M, Metzendorf MI, Rubinat E, Mauricio D. Perioperative glycaemic control for people with diabetes undergoing surgery. Cochrane Database Syst Rev 2023; 8:CD007315. [PMID: 37526194 PMCID: PMC10392034 DOI: 10.1002/14651858.cd007315.pub3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/02/2023]
Abstract
BACKGROUND People with diabetes mellitus are at increased risk of postoperative complications. Data from randomised clinical trials and meta-analyses point to a potential benefit of intensive glycaemic control, targeting near-normal blood glucose, in people with hyperglycaemia (with and without diabetes mellitus) being submitted for surgical procedures. However, there is limited evidence concerning this question in people with diabetes mellitus undergoing surgery. OBJECTIVES To assess the effects of perioperative glycaemic control for people with diabetes undergoing surgery. SEARCH METHODS For this update, we searched the databases CENTRAL, MEDLINE, LILACS, WHO ICTRP and ClinicalTrials.gov. The date of last search for all databases was 25 July 2022. We applied no language restrictions. SELECTION CRITERIA We included randomised controlled clinical trials (RCTs) that prespecified different targets of perioperative glycaemic control for participants with diabetes (intensive versus conventional or standard care). DATA COLLECTION AND ANALYSIS Two authors independently extracted data and assessed the risk of bias. Our primary outcomes were all-cause mortality, hypoglycaemic events and infectious complications. Secondary outcomes were cardiovascular events, renal failure, length of hospital and intensive care unit (ICU) stay, health-related quality of life, socioeconomic effects, weight gain and mean blood glucose during the intervention. We summarised studies using meta-analysis with a random-effects model and calculated the risk ratio (RR) for dichotomous outcomes and the mean difference (MD) for continuous outcomes, using a 95% confidence interval (CI), or summarised outcomes with descriptive methods. We used the GRADE approach to evaluate the certainty of the evidence (CoE). MAIN RESULTS A total of eight additional studies were added to the 12 included studies in the previous review leading to 20 RCTs included in this update. A total of 2670 participants were randomised, of which 1320 were allocated to the intensive treatment group and 1350 to the comparison group. The duration of the intervention varied from during surgery to five days postoperative. No included trial had an overall low risk of bias. Intensive glycaemic control resulted in little or no difference in all-cause mortality compared to conventional glycaemic control (130/1263 (10.3%) and 117/1288 (9.1%) events, RR 1.08, 95% CI 0.88 to 1.33; I2 = 0%; 2551 participants, 18 studies; high CoE). Hypoglycaemic events, both severe and non-severe, were mainly experienced in the intensive glycaemic control group. Intensive glycaemic control may slightly increase hypoglycaemic events compared to conventional glycaemic control (141/1184 (11.9%) and 41/1226 (3.3%) events, RR 3.36, 95% CI 1.69 to 6.67; I2 = 64%; 2410 participants, 17 studies; low CoE), as well as those considered severe events (37/927 (4.0%) and 6/969 (0.6%), RR 4.73, 95% CI 2.12 to 10.55; I2 = 0%; 1896 participants, 11 studies; low CoE). Intensive glycaemic control, compared to conventional glycaemic control, may result in little to no difference in the rate of infectious complications (160/1228 (13.0%) versus 224/1225 (18.2%) events, RR 0.75, 95% CI 0.55 to 1.04; P = 0.09; I2 = 55%; 2453 participants, 18 studies; low CoE). Analysis of the predefined secondary outcomes revealed that intensive glycaemic control may result in a decrease in cardiovascular events compared to conventional glycaemic control (107/955 (11.2%) versus 125/978 (12.7%) events, RR 0.73, 95% CI 0.55 to 0.97; P = 0.03; I2 = 44%; 1454 participants, 12 studies; low CoE). Further, intensive glycaemic control resulted in little or no difference in renal failure events compared to conventional glycaemic control (137/1029 (13.3%) and 158/1057 (14.9%), RR 0.92, 95% CI 0.69 to 1.22; P = 0.56; I2 = 38%; 2086 participants, 14 studies; low CoE). We found little to no difference between intensive glycaemic control and conventional glycaemic control in length of ICU stay (MD -0.10 days, 95% CI -0.57 to 0.38; P = 0.69; I2 = 69%; 1687 participants, 11 studies; low CoE), and length of hospital stay (MD -0.79 days, 95% CI -1.79 to 0.21; P = 0.12; I2 = 77%; 1520 participants, 12 studies; very low CoE). Due to the differences within included studies, we did not pool data for the reduction of mean blood glucose. Intensive glycaemic control resulted in a mean lowering of blood glucose, ranging from 13.42 mg/dL to 91.30 mg/dL. One trial assessed health-related quality of life in 12/37 participants in the intensive glycaemic control group, and 13/44 participants in the conventional glycaemic control group; no important difference was shown in the measured physical health composite score of the short-form 12-item health survey (SF-12). One substudy reported a cost analysis of the population of an included study showing a higher total hospital cost in the conventional glycaemic control group, USD 42,052 (32,858 to 56,421) compared to the intensive glycaemic control group, USD 40,884 (31.216 to 49,992). It is important to point out that there is relevant heterogeneity between studies for several outcomes. We identified two ongoing trials. The results of these studies could add new information in future updates on this topic. AUTHORS' CONCLUSIONS High-certainty evidence indicates that perioperative intensive glycaemic control in people with diabetes undergoing surgery does not reduce all-cause mortality compared to conventional glycaemic control. There is low-certainty evidence that intensive glycaemic control may reduce the risk of cardiovascular events, but cause little to no difference to the risk of infectious complications after the intervention, while it may increase the risk of hypoglycaemia. There are no clear differences between the groups for the other outcomes. There are uncertainties among the intensive and conventional groups regarding the optimal glycaemic algorithm and target blood glucose concentrations. In addition, we found poor data on health-related quality of life, socio-economic effects and weight gain. It is also relevant to underline the heterogeneity among studies regarding clinical outcomes and methodological approaches. More studies are needed that consider these factors and provide a higher quality of evidence, especially for outcomes such as hypoglycaemia and infectious complications.
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Affiliation(s)
- Filip Bellon
- Healthcare Research Group (GRECS), Institute of Biomedical Research in Lleida (IRBLleida), Lleida, Spain
- GESEC group, Department of Nursing and Physiotherapy, Faculty of Nursing and Physiotherapy, University of Lleida, Lleida, Spain
| | - Ivan Solà
- Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau (IIB Sant Pau), CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - Gabriel Gimenez-Perez
- Endocrinology Section, Department of Medicine, Hospital General de Granollers, Granollers, Spain
- Department of Medicine, Faculty of Medicine and Health Sciences, Universitat Internacional de Catalunya, Sant Cugat del Vallés, Spain
| | - Marta Hernández
- Department of Endocrinology and Nutrition, Hospital Universitari Arnau de Vilanova, Institut de Recerca Biomèdica de Lleida (IRBLLEIDA), Lleida, Spain
| | - Maria-Inti Metzendorf
- Institute of General Practice, Medical Faculty of the Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Esther Rubinat
- Healthcare Research Group (GRECS), Institute of Biomedical Research in Lleida (IRBLleida), Lleida, Spain
- GESEC group, Department of Nursing and Physiotherapy, Faculty of Nursing and Physiotherapy, University of Lleida, Lleida, Spain
- CIBER of Diabetes and Associated Metabolic Disease, Barcelona, Spain
| | - Didac Mauricio
- CIBER of Diabetes and Associated Metabolic Disease, Barcelona, Spain
- Department of Endocrinology and Nutrition, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
- Department of Medicine, Faculty of Medicine, University of Vic & Central University of Catalonia, Vic, Spain
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Shah K, Gögenur I, Gislason H. High preoperative HbA1c does not affect early or late complication rates after bariatric surgery. Surg Endosc 2023:10.1007/s00464-023-10009-w. [PMID: 36991264 DOI: 10.1007/s00464-023-10009-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Accepted: 03/09/2023] [Indexed: 03/30/2023]
Abstract
BACKGROUND Preoperative HbA1c has been associated with an increased incidence of postoperative morbidity and mortality after abdominal and cardiovascular surgery. The literature on bariatric surgery is inconclusive and guidelines recommend postponement of surgery when HbA1c is above an arbitrary threshold (≥ 8.5%). In this study, we sought to understand the impact of preoperative HbA1c on early and late postoperative complications. METHODS We performed a retrospective analysis of prospectively collected data on obese patients with diabetes who underwent laparoscopic bariatric surgery. Patients were categorized into three groups according to their preoperative HbA1c level: < 6.5% (group 1), 6.5-8.4% (group 2) and ≥ 8.5% (group 3). Primary outcomes were early and late postoperative complications (< and > 30 days, respectively) that were differentiated based on severity (major/minor). Secondary outcomes were length of stay (LOS), duration of surgery, and rate of readmission. RESULTS In total, 6798 patients underwent laparoscopic bariatric surgery from 2006 to 2016, of which 1021 (15%) patients had Type 2 Diabetes (T2D). Complete data with a median follow-up of 45 months (3-120) were available for 914 patients with HbA1c < 6.5% (n = 227, 24.9%), 6.5-8.4% (n = 532, 58.5%) and ≥ 8.5% (n = 152, 16.6%). Early major surgical complication rate was similar across the groups ranging from 2.6 to 3.3%. No associations between high preoperative HbA1c and late complications-medical as well as surgical-was observed. Groups 2 and 3 had statistically significant more pronounced inflammatory status. LOS (1.8-1.9 days), readmission rates (1.7-2.0%) and surgical time was similar across the three groups. CONCLUSION Elevated HbA1c is not associated with more early or late postoperative complications, longer LOS, longer surgical time or higher rates of readmission.
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Nutritional Interventions for Patients with Severe Obesity Seeking Bariatric Surgery. Nutrients 2023; 15:nu15030515. [PMID: 36771222 PMCID: PMC9919116 DOI: 10.3390/nu15030515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 01/10/2023] [Indexed: 01/21/2023] Open
Abstract
Bariatric surgery (BS) is usually considered when other weight-loss treatments have failed, and remains an effective long-term treatment for severe obesity and its related medical complications [...].
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Comment on: “Intensive glucose control during the perioperative period for diabetic patients undergoing surgery: An updated systematic review and meta-analysis”. J Clin Anesth 2022; 78:110680. [PMID: 35152080 DOI: 10.1016/j.jclinane.2022.110680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 01/31/2022] [Indexed: 11/23/2022]
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Bhattacharya S, Kalra S, Kapoor N, Singla R, Dutta D, Aggarwal S, Khandelwal D, Surana V, Dhingra A, Kantroo V, Chittawar S, Deka N, Bindal V, Dutta P. Expert opinion on the preoperative medical optimization of adults with diabetes undergoing metabolic surgery. World J Diabetes 2021; 12:1587-1621. [PMID: 34754367 PMCID: PMC8554368 DOI: 10.4239/wjd.v12.i10.1587] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 07/18/2021] [Accepted: 08/25/2021] [Indexed: 02/06/2023] Open
Abstract
Diabetes mellitus (DM) and obesity are interrelated in a complex manner, and their coexistence predisposes patients to a plethora of medical problems. Metabolic surgery has evolved as a promising therapeutic option for both conditions. It is recommended that patients, particularly those of Asian origin, maintain a lower body mass index threshold in the presence of uncontrolled DM. However, several comorbidities often accompany these chronic diseases and need to be addressed for successful surgical outcome. Laparoscopic Roux-en-Y gastric bypass (RYGB) and laparoscopic sleeve gastrectomy (LSG) are the most commonly used bariatric procedures worldwide. The bariatric benefits of RYGB and LSG are similar, but emerging evidence indicates that RYGB is more effective than LSG in improving glycemic control and induces higher rates of long-term DM remission. Several scoring systems have been formulated that are utilized to predict the chances of remission. A glycemic target of glycated hemoglobin < 7% is a reasonable goal before surgery. Cardiovascular, pulmonary, gastrointestinal, hepatic, renal, endocrine, nutritional, and psychological optimization of surgical candidates improves perioperative and long-term outcomes. Various guidelines for preoperative care of individuals with obesity have been formulated, but very few specifically focus on the concerns arising from the presence of concomitant DM. It is hoped that this statement will lead to the standardization of presurgical management of individuals with DM undergoing metabolic surgery.
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Affiliation(s)
| | - Sanjay Kalra
- Endocrinology, Bharti Hospital, Karnal 132001, Haryana, India
| | - Nitin Kapoor
- Endocrinology, Christian Medical College, Vellore 632004, Tamil Nadu, India
| | - Rajiv Singla
- Endocrinology, Kalpavriksh Super Speciality Center, New Delhi 110075, India
| | - Deep Dutta
- Endocrinology, CEDAR Superspecialty Clinic, New Delhi 110075, India
| | - Sameer Aggarwal
- Endocrinology, Apex Plus Superspeciality Hospital, Rohtak 124001, Haryana, India
| | | | - Vineet Surana
- Endocrinology, Manipal Hospitals, New Delhi 110075, India
| | - Atul Dhingra
- Endocrinology, Gangaram Bansal Super Speciality Hospital, Sri Ganganagar 335001, Rajasthan, India
| | - Viny Kantroo
- Respiratory Medicine & Critical Care, Indraprastha Apollo Hospitals, Sarita Vihar, New Delhi 110076, India
| | - Sachin Chittawar
- Endocrinology, Gandhi Medical College, Bhopal 462001, Madhya Pardesh, India
| | - Nilakshi Deka
- Endocrinology, Apollo Hospitals, Guwahati 781005, Assam, India
| | - Vivek Bindal
- Minimal Access, Metabolic and Bariatric surgery, Max Superspeciality Hospital, Patparganj, New Delhi 110092, India
| | - Puja Dutta
- Nutrition, Max Superspeciality Hospital, Patparganj, New Delhi 110092, India
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Carter J, Chang J, Birriel TJ, Moustarah F, Sogg S, Goodpaster K, Benson-Davies S, Chapmon K, Eisenberg D. ASMBS position statement on preoperative patient optimization before metabolic and bariatric surgery. Surg Obes Relat Dis 2021; 17:1956-1976. [PMID: 34629296 DOI: 10.1016/j.soard.2021.08.024] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 08/11/2021] [Accepted: 08/27/2021] [Indexed: 12/12/2022]
Affiliation(s)
- Jonathan Carter
- Clinical Issues Committee, American Society of Metabolic and Bariatric Surgeons; Department of Clinical Surgery, University of California-San Francisco, San Francisco, California.
| | - Julietta Chang
- Clinical Issues Committee, American Society of Metabolic and Bariatric Surgeons; Department of Clinical Surgery, University of California-San Francisco, San Francisco, California
| | - T Javier Birriel
- Clinical Issues Committee, American Society of Metabolic and Bariatric Surgeons; Department of Clinical Surgery, University of California-San Francisco, San Francisco, California
| | - Fady Moustarah
- Clinical Issues Committee, American Society of Metabolic and Bariatric Surgeons; Department of Clinical Surgery, University of California-San Francisco, San Francisco, California
| | - Stephanie Sogg
- Clinical Issues Committee, American Society of Metabolic and Bariatric Surgeons; Department of Clinical Surgery, University of California-San Francisco, San Francisco, California
| | - Kasey Goodpaster
- Clinical Issues Committee, American Society of Metabolic and Bariatric Surgeons; Department of Clinical Surgery, University of California-San Francisco, San Francisco, California
| | - Sue Benson-Davies
- Clinical Issues Committee, American Society of Metabolic and Bariatric Surgeons; Department of Clinical Surgery, University of California-San Francisco, San Francisco, California
| | - Katie Chapmon
- Clinical Issues Committee, American Society of Metabolic and Bariatric Surgeons; Department of Clinical Surgery, University of California-San Francisco, San Francisco, California
| | - Dan Eisenberg
- Clinical Issues Committee, American Society of Metabolic and Bariatric Surgeons; Department of Clinical Surgery, University of California-San Francisco, San Francisco, California
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Jiang J, Li S, Zhao Y, Zhou Z, Zhang J, Sun R, Luo A. Intensive glucose control during the perioperative period for diabetic patients undergoing surgery: An updated systematic review and meta-analysis. J Clin Anesth 2021; 75:110504. [PMID: 34509960 DOI: 10.1016/j.jclinane.2021.110504] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 08/29/2021] [Accepted: 09/04/2021] [Indexed: 12/29/2022]
Abstract
STUDY OBJECTIVE To evaluate the impact of intensive glucose control on diabetic patients undergoing surgery. DESIGN A systematic review and meta-analysis of randomized controlled trials. PubMed, CENTRAL, EMBASE, ISI Web of Science, and CINAHL databases were searched from inception to 13 December 2020. SETTING Operating room, postoperative recovery area and ward, up to 30 days after surgery. PATIENTS Diabetic patients undergoing surgery. INTERVENTIONS We used Review Manager 5.4 to pool the data with a random-effects model. The quality of evidence was rated using the Grading of Recommendations, Assessment, Development and Evaluation system. MEASUREMENTS The primary outcomes were infectious complications, postoperative mortality, and hypoglycaemia. The secondary outcomes included atrial fibrillation, myocardial infarction, stroke, delirium, renal failure, postoperative mechanical ventilation time, length of intensive care unit (ICU) stay, and hospital stay. MAIN RESULTS Thirteen studies involving 1582 participants were included. Compared with conventional glucose control, intensive glucose control was associated with a lower risk of infectious complications (risk ratio [RR], 0.35; 95% confidence interval [CI], 0.19-0.63; low-quality evidence), atrial fibrillation (RR, 0.55; 95% CI, 0.42-0.71; high-quality evidence), and renal failure (RR, 0.38; 95% CI, 0.15-0.95; moderate-quality evidence), as well as a shorter length of stay in the ICU (mean difference (MD), -0.55 day; 95% CI, -1.05 to -0.05 days; very-low-quality evidence) and hospital (MD, -1.61 days; 95% CI, -2.78 to -0.44 days; very-low-quality evidence). However, intensive glucose control was associated with a higher risk of hypoglycaemia (RR, 3.00; 95% CI, 1.97-4.55; high-quality evidence). There were no significant differences in postoperative mortality, myocardial infarction, stroke, delirium, or postoperative mechanical ventilation time. CONCLUSIONS Intensive glucose control in diabetic patients is associated with a reduction in some adverse postoperative outcomes including infectious complications, but also appears to increase the risk of hypoglycaemia. Further well-designed studies may be needed to determine appropriate regimens to reduce hypoglycaemia incidence. PROSPERO REGISTRATION NUMBER CRD42021226138.
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Affiliation(s)
- Jie Jiang
- Department of Anesthesiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Shiyong Li
- Department of Anesthesiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Yilin Zhao
- Department of Anesthesiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Zhiqiang Zhou
- Department of Anesthesiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Jie Zhang
- Department of Anesthesiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Rao Sun
- Department of Anesthesiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China.
| | - Ailin Luo
- Department of Anesthesiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China.
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Type 2 Diabetes Mellitus and Preoperative HbA1c Level Have no Consequence on Outcomes after Laparoscopic Sleeve Gastrectomy—a Cohort Study. Obes Surg 2019; 29:2957-2962. [DOI: 10.1007/s11695-019-03936-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Howard ML, Steuber TD, Nisly SA. Glycemic Management in the Bariatric Surgery Population: A Review of the Literature. Pharmacotherapy 2018; 38:663-673. [DOI: 10.1002/phar.2120] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- Meredith L. Howard
- Department of Pharmacotherapy; University of North Texas System College of Pharmacy; Fort Worth Texas
| | - Taylor D. Steuber
- Department of Pharmacy Practice; Auburn University Harrison School of Pharmacy; Huntsville Alabama
| | - Sarah A. Nisly
- Wingate University School of Pharmacy; Wingate North Carolina
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Telem DA, Gould J, Pesta C, Powers K, Majid S, Greenberg JA, Teixeira A, Brounts L, Lin H, DeMaria E, Rosenthal R. American Society for Metabolic and Bariatric Surgery: care pathway for laparoscopic sleeve gastrectomy. Surg Obes Relat Dis 2017; 13:742-749. [DOI: 10.1016/j.soard.2017.01.027] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Accepted: 01/20/2017] [Indexed: 02/06/2023]
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The effects of optimal perioperative glucose control on morbidly obese patients undergoing bariatric surgery. Surg Endosc 2016; 31:1407-1413. [DOI: 10.1007/s00464-016-5129-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Accepted: 07/13/2016] [Indexed: 10/21/2022]
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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.
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Affiliation(s)
- David Rometo
- Division of Endocrinology, Diabetes, and Metabolism, University of Pittsburgh Medical Center (UPMC), University of Pittsburgh School of Medicine, 200 Lothrop Avenue, Pittsburgh, PA, 15213, USA.
| | - Mary Korytkowski
- Division of Endocrinology, Diabetes, and Metabolism, University of Pittsburgh Medical Center (UPMC), University of Pittsburgh School of Medicine, 200 Lothrop Avenue, Pittsburgh, PA, 15213, USA.
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