医学
血糖性
围手术期
2型糖尿病
糖尿病
外科
肥胖
胰岛素
减肥
重症监护医学
内科学
内分泌学
作者
Oscar L. Morey‐Vargas,Ali Aminian,Karen Steckner,Keren Zhou,Sangeeta R. Kashyap,Derrick Cetin,Kevin M. Pantalone,Christopher R. Daigle,Marcio L. Griebeler,W. Scott Butsch,Robert S. Zimmerman,Matthew Kroh,Hanane Saadi,Danielle Diemer,Bartolomé Burguera,Raúl J. Rosenthal,M. Cecilia Lansang
标识
DOI:10.1016/j.soard.2022.05.008
摘要
Bariatric and metabolic surgery is an effective treatment for patients with severe obesity and obesity-related diseases. In patients with type 2 diabetes, it provides marked improvement in glycemic control and even remission of diabetes. In patients with type 1 diabetes, bariatric surgery may offer improvement in insulin sensitivity and other cardiometabolic risk factors, as well as amelioration of the mechanical complications of obesity. Because of these positive outcomes, there are increasing numbers of patients with diabetes who undergo bariatric surgical procedures each year. Prior to surgery, efforts should be made to optimize glycemic control. However, there is no need to delay or withhold bariatric surgery until a specific glycosylated hemoglobin target is reached. Instead, treatment should focus on avoidance of early postoperative hyperglycemia. In general, oral glucose-lowering medications and noninsulin injectables are not favored to control hyperglycemia in the inpatient setting. Hyperglycemia in the hospital is managed with insulin, aiming for perioperative blood glucose concentrations between 80 and 180 mg/dL. Following surgery, substantial changes of the antidiabetic medication regimens are common. Patients should have a clear understanding of the modifications made to their treatment and should be followed closely thereafter. In this review article, we describe practical recommendations for the perioperative management of diabetes in patients with type 2 or type 1 diabetes undergoing bariatric surgery. Specific recommendations are delineated based on the different treatments that are currently available for glycemic control, including oral glucose-lowering medications, noninsulin injectables, and a variety of insulin regimens.
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