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Management of Diabetes in Patients Undergoing Bariatric Surgery

  • Obesity (KM Gadde, Section Editor)
  • Published:
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Abstract

Purpose of Review

The number of bariatric surgeries for patients with type 1 or type 2 diabetes continues to grow. Clinicians are challenged to choose therapies that reach glycemic targets without inducing adverse effects in post-bariatric patients without published guidelines. This review evaluates data supporting the best strategies for diabetes management in patients undergoing bariatric surgery.

Recent Findings

Though few clinical trials have evaluated the safety and effectiveness of different glucose-lowering therapies following bariatric surgery, remission of diabetes or reduced medications is an established benefit of bariatric surgery. Adverse events including diabetic ketoacidosis in post-bariatric patients on sodium-glucose co-transporter 2 (SGLT2) inhibitors or inadequate insulin have been reported in patient's with both type 1 and type 2 diabetes. Metformin, glucagon-like peptide-1 (GLP-1) agonists, dipeptidyl peptidase-4 (DPP-4) inhibitors, SGLT2 inhibitors, insulin, and sulfonylureas have been used successfully in the perioperative period for other surgeries and guidelines recommend adjusting the doses of these medications especially in the perioperative period.

Summary

Clinicians should favor weight-neutral or weight-loss promoting therapies in post-bariatric surgery patients such as medical nutrition therapy, metformin, GLP-1 agonists, SGLT2 inhibitors, and DPP-4 inhibitors.

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Acknowledgments

We would like to thank Dr. Bethany M. Mulla, MD, for proofreading the manuscript.

The views expressed in this article are those of the authors and do not reflect the official policy or position of the Department of the Army, Department of Defense, or the U.S. Government.

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  1. Division of Endocrinology, Landstuhl Regional Medical Center, US Army, Landstuhl, Germany

    Christopher M. Mulla & Harris M. Baloch

  2. Joslin Diabetes Center, Harvard Medical School, Boston, MA, USA

    Christopher M. Mulla & Samar Hafida

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Mulla, C.M., Baloch, H.M. & Hafida, S. Management of Diabetes in Patients Undergoing Bariatric Surgery. Curr Diab Rep 19, 112 (2019). https://doi.org/10.1007/s11892-019-1242-2

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