Expert opinion on the preoperative medical optimization of adults with diabetes undergoing metabolic surgery

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.

Position statement: surgery and diabetes mellitus (Update 2023)

“…Der HbA1c-Wert ist international als Surrogat Parameter der langfristigen glykämischen Kontrolle akzeptiert. Im perioperativen Kontext konnte eine Korrelation zu schlechteren postoperativen Ergebnissen bei erhöhten HbA1c-Werten gezeigt werden [42][43][44][45][46][47]. Es wird jedoch kontroversiell diskutiert, ob das HbA1c als zuverlässiger Prädiktor postoperativer Komplikationen tatsächlich geeignet oder ob nicht die akute perioperative Stoffwechsellage ein besserer Marker ist [48][49][50][51][52].…”