Obesity Surgery

, Volume 22, Issue 1, pp 90–96

Can a Protocol for Glycaemic Control Improve Type 2 Diabetes Outcomes After Gastric Bypass?

  • Wiebke K. Fenske
  • Dimitri J. Pournaras
  • Erlend T. Aasheim
  • Alexander D. Miras
  • Nicola Scopinaro
  • Samantha Scholtz
  • Carel W. le Roux
Clinical Research

Abstract

Background

Roux-en-Y gastric bypass surgery (RYGB) is an effective treatment for patients with type 2 diabetes (T2DM). Tight glycaemic control immediately after RYGB for T2DM may improve long-term glycaemic outcomes, but is also associated with a higher risk of hypoglycaemia. We designed a treatment algorithm to achieve optimal glycaemic control in patients with insulin-treated T2DM after RYGB and evaluated its feasibility, safety and efficacy.

Methods

Fifty patients following protocol-driven diabetes management were discharged on a fixed amount of metformin and glargine, with the insulin dose adjusted according to a standardised insulin sliding scale aiming for a fasting capillary glucose (FCG) of 5.5–6.9 mmol/L. Glycaemic outcome and remission of diabetes (defined as HbA1c < 6% and FCG levels < 5.6 mmol/L for at least 1 year without hypoglycaemic medication) were compared between patients who received protocol-driven treatment and a similar cohort of 49 patients following standard glycaemic management.

Results

At 1 year follow-up, the protocol-driven group showed a greater improvement in glycaemic control than the non-protocol-driven group (HbA1c −3.0 ± 0.2% vs. −1.2 ± 0.1%, P < 0.001; FCG levels −3.4 ± 0.2 vs. −2.0 ± 0.2 mmol/L, P = 0.02) and a higher remission rate from T2DM (50.0% vs. 6.1%, P < 0.001). No symptomatic hypoglycaemia was reported in either group.

Conclusions

The protocol-driven management proved to be feasible, safe and effective in achieving targeted glycaemic control in T2DM after RYGB. The next step will be to scrutinise the efficacy of protocol-driven management in a randomised controlled clinical trial.

Keywords

Bariatric Diabetes Gastric bypass Glycaemic control Insulin 

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Copyright information

© Springer Science + Business Media, LLC 2011

Authors and Affiliations

  • Wiebke K. Fenske
    • 1
    • 2
  • Dimitri J. Pournaras
    • 1
  • Erlend T. Aasheim
    • 1
  • Alexander D. Miras
    • 1
  • Nicola Scopinaro
    • 3
  • Samantha Scholtz
    • 1
  • Carel W. le Roux
    • 1
  1. 1.Department of Investigative MedicineImperial Weight Centre, Imperial College LondonLondonUK
  2. 2.Department of Internal Medicine I, Endocrine and Diabetes UnitUniversity Hospital WürzburgWürzburgGermany
  3. 3.University of Genoa Medical SchoolGenoaItaly

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