Continuous glucose monitoring in patients with remission of type 2 diabetes after laparoscopic sleeve gastrectomy without or with duodenojejunal bypass

Abstract

Summary Bariatric surgery is associated with a high remission rate of type 2 diabetes mellitus. However, it is unclear whether patients showing remission of diabetes actually have normal blood glucose levels throughout the day. We therefore performed continuous glucose monitoring (CGM) in 15 ambulatory patients showing remission of diabetes after laparoscopic sleeve gastrectomy (LSG) without or with duodenojejunal bypass (DJB) at the time of diabetic remission (12.9 ± 1.8 months after bariatric surgery). The definition of remission of diabetes was based on the American Diabetes Association criteria. The mean, SD, and coefficient of variation (CV) of glucose calculated from CGM were 6.2 ± 0.6 mmol/L, 1.5 ± 0.4 mmol/L, and 23.7 ± 6.2%, respectively. These values were higher than those of healthy participants without diabetes previously reported. The percentages of time spent above 10.0 mmol/L and below 3.9 mmol/L were 2.6 (IQR 0‐5.0)% and 0 (IQR 0‐8.0)%, respectively. Thus, patients with remission of diabetes after LSG or LSG/DJB still had substantial periods of hyperglycemia and hypoglycemia throughout the day. Therefore, we must manage patients with diabetes carefully, even after apparent remission of type 2 diabetes in response to bariatric surgery.

Comparison between the Effect of Laparoscopic Sleeve Gastrectomy and Laparoscopic Mini-gastric Bypass on Type 2 Diabetes Mellitus in Obese Patients: A Prospective Study

“…19 Many studies discussed these benefits and the effects of the aforementioned procedures on T2DM, hyperlipidemia, and hypertension either for short-term follow-up or for long-term follow-up with the presence of promising results in controlling many of these comorbidities. 20,21 and controlling high blood glucose levels in T2DM. LMGB has a significant superiority over LSG in controlling patients with T2DM and weight reduction.…”

Metabolic surgery in treatment of obese Japanese patients with type 2 diabetes: a joint consensus statement from the Japanese Society for Treatment of Obesity, the Japan Diabetes Society, and the Japan Society for the Study of Obesity

“…Postoperative withdrawing from insulin or starting SGLT2 inhibitors occasionally causes diabetic ketoacidosis, suggesting that diabetes medication should be carefully considered after surgery [ 206 ]. As postprandial reactive hypoglycemia may occur after LSG [ 207 ], continuous blood glucose monitoring should be considered to use for preventing the hypoglycemic events [ 208 ]. If a patient has advanced diabetic retinopathy before surgery, the rapid improvement in blood glucose levels after surgery may aggravate the retinopathy.…”

Continuous glucose monitoring captures glycemic variability in obesity after sleeve gastrectomy: A prospective cohort study

“…GV is associated with inflammation as well as mortality in diabetes 5 . Continuous glucose monitoring (CGM) was recently deployed to evaluate type 2 diabetes glycemic concentrations following sleeve gastrectomy (SG), but few studies have evaluated such changes in normoglycemic obesity 6 . Whether GV can be an alternative to HbA1c for assessing glycemic status, after metabolic and bariatric surgery, is unclear.…”

“…5 Continuous glucose monitoring (CGM) was recently deployed to evaluate type 2 diabetes glycemic concentrations following sleeve gastrectomy (SG), but few studies have evaluated such changes in normoglycemic obesity. 6 Whether GV can be an alternative to HbA1c for assessing glycemic status, after metabolic and bariatric surgery, is unclear. Identifying dysglycemia after metabolic and bariatric surgery allows for earlier prescription of lifestyle modification or medications to lower glucose concentrations and to modify CVD risk factors.…”