The Impact of Bariatric Surgery on Type 2 Diabetes Mellitus and the Management of Hypoglycemic Events

Abstract

Recent studies discussed the benefit of bariatric surgery on obese patients diagnosed with type 2 diabetes mellitus (T2DM). Several factors play an essential role in predicting the impact of bariatric surgery on T2DM, such as ABCD score (age, BMI, C-peptide, and duration of the disease), HbA1c, and fasting blood glucose, incretins [glucagon-like peptide-1 (GLP-1) and gastric inhibitory peptide (GIP)]. DiaRem score known to include factors such as age, HbA1c, medication, and insulin usage used to predict the remission of T2DM, but it has some limitations. An extensive literature search was conducted on PubMed and Google Scholar using keywords such as gastric bypass, T2DM, bariatric surgery, GLP-1, GIP, and post bariatric hypoglycemia. Restrictive-malabsorptive procedures are most effective in treating T2DM patients based on changes induced in appetite through regulation of gastrointestinal hormones, with decreased hunger and increased satiation. We provide a review of bariatric surgery influence on T2DM and management of post-intervention hypoglycemic events. Post-bariatric surgery hypoglycemia is a serious complication especially when patients develop life-threatening neuroglycopenia with loss of consciousness and seizure. The avoidance of this adverse event may be achieved by strict dietary modification including a restriction on carbohydrates as well as foods with high glycemic index. Further research will provide more information on post-bariatric surgery hyperinsulinemic hypoglycemia pathophysiology and management.

Glycemic Management in the Bariatric Surgery Population: A Review of the Literature

“…Regardless of which insulin protocol was used, an important consideration is that patients undergoing bariatric surgery may have labile glycemic control postoperatively . Hormonal alterations coupled with aggressive caloric intake restrictions necessitate close blood glucose monitoring and timely adjustments in antihyperglycemic therapy.…”

“…14,22 The proposed mechanism of PBH is not well understood, but hypotheses include increased GLP-1 secretion after meals, beta-cell hyperplasia contributing to elevated insulin levels, and altered intestinal microbiota and bile acids. 14 The most important strategy for treatment of PBH is prevention. Blood glucose levels should be regularly checked and kept within normal limits, with medication adjustment as needed.…”

“…Although beneficial long term, these responses may lead to difficulties in perioperative blood glucose management. Because of these mechanisms, patients with T2DM may fluctuate between hyperglycemia and hypoglycemia . As patients progress after surgery to the long‐term postoperative setting, weight loss causes sustained alterations in peripheral insulin sensitivity.…”

“…Because of these mechanisms, patients with T2DM may fluctuate between hyperglycemia and hypoglycemia. 14 As patients progress after surgery to the long-term postoperative setting, weight loss causes sustained alterations in peripheral insulin sensitivity. The combination of immediate gastrointestinal tract nutrient processing and long-term benefits seen with profound weight loss leads to euglycemia and possible resolution of T2DM.…”

Possibilities of metabolic surgery for the treatment of type 2 diabetes mellitus in patients with grade 1 alimentary obesity

“…Чем выше его уровень (как базальный, так и стимулированный), тем большее влияние на углеводный обмен окажет БОВ [36,37]. И только возраст пациента, с точки зрения патоморфоза СД2, является, по сути, малоценным показателем, но, отражая компенсаторные возможности организма, помогает прогнозировать общий исход бариатрической операции [38]. Кроме того, к предикторам лучших послеоперационных результатов в отношении нарушений углеводного обмена относят наличие большого количества висцерального жира у пациента, особенно у пациентов азиатского происхождения [39].…”