Skip to main content
SpringerLink
Log in

Diabetes After Bariatric Surgery

  • Chapter
  • First Online:
Diabetes Management in Hospitalized Patients

Part of the book series: Contemporary Endocrinology ((COE))

  • 257 Accesses

Abstract

Obesity and type 2 diabetes are rising globally, and obesity is a significant risk factor for the development of type 2 diabetes. Bariatric surgery has been shown to be an effective treatment for obesity that results in rapid glycemic improvement in patients with comorbid diabetes. Hospitalized patients with diabetes require glucose monitoring in the perioperative period after bariatric surgery and may need treatment with scheduled insulin to maintain glucose levels at target. Upon discharge from the hospital, diabetes medications can generally be reduced or discontinued.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 169.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Hardcover Book
USD 219.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. World Health Organization. 2021. https://www.who.int/news-room/fact-sheets/detail/obesity-and-overweight. Accessed 31 Oct 2022.

  2. Jih J, Mukherjea A, Vittinghoff E, Nguyen TT, Tsoh JY, Fukuoka Y, Bender MS, Tseng W, Kanaya AM. Using appropriate body mass index cut points for overweight and obesity among Asian Americans. Prev Med (Baltim). 2014;65:1–6.

    Article  Google Scholar 

  3. Sjostrom LV. Mortality of severely obese subjects. Am J Clin Nutr. 1992;55:516S. https://doi.org/10.1093/ajcn/55.2.516s.

    Article  CAS  PubMed  Google Scholar 

  4. Must A, Spadano J, Coakley EH, Field AE, Colditz G, Dietz WH. The disease burden associated with overweight and obesity. J Am Med Assoc. 1999;282:1523. https://doi.org/10.1001/jama.282.16.1523.

    Article  CAS  Google Scholar 

  5. Yanovski SZ. Overweight, obesity, and health risk: National Task Force on the prevention and treatment of obesity. Arch Intern Med. 2000;160:898. https://doi.org/10.1001/archinte.160.7.898.

    Article  Google Scholar 

  6. Adult Obesity Facts. In: Centers of Disease Control and Prevention. 2022. https://www.cdc.gov/obesity/data/adult.html. Accessed 31 Oct 2022.

  7. Risk factors for diabetes-related complications. In: Centers for Disease Control and Prevention; 2022. https://www.cdc.gov/diabetes/data/statistics-report/risks-complications.html. Accessed 31 Oct 2022.

  8. Obesity and weight Management for the Prevention and Treatment of type 2 diabetes: standards of medical Care in Diabetes—2022. Diabetes Care. 2022;45:S113. https://doi.org/10.2337/dc22-S008.

  9. Mingrone G, Panunzi S, de Gaetano A, Guidone C, Iaconelli A, Nanni G, Castagneto M, Bornstein S, Rubino F. Bariatric–metabolic surgery versus conventional medical treatment in obese patients with type 2 diabetes: 5 year follow-up of an open-label, single-centre, randomised controlled trial. Lancet. 2015;386:964–73.

    Article  PubMed  Google Scholar 

  10. Courcoulas AP, Goodpaster BH, Eagleton JK, Belle SH, Kalarchian MA, Lang W, Toledo FGS, Jakicic JM. Surgical vs medical treatments for type 2 diabetes mellitus. JAMA Surg. 2014;149:707.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Cummings DE, Arterburn DE, Westbrook EO, et al. Gastric bypass surgery vs intensive lifestyle and medical intervention for type 2 diabetes: the CROSSROADS randomised controlled trial. Diabetologia. 2016;59:945–53.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  12. Ikramuddin S, Billington CJ, Lee W-J, et al. Roux-en-Y gastric bypass for diabetes (the diabetes surgery study): 2-year outcomes of a 5-year, randomised, controlled trial. Lancet Diabetes Endocrinol. 2015;3:413–22.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Liang Z, Wu Q, Chen B, Yu P, Zhao H, Ouyang X. Effect of laparoscopic Roux-en-Y gastric bypass surgery on type 2 diabetes mellitus with hypertension: a randomized controlled trial. Diabetes Res Clin Pract. 2013;101:50–6.

    Article  PubMed  Google Scholar 

  14. Parikh M, Chung M, Sheth S, et al. Randomized pilot trial of bariatric surgery versus intensive medical weight management on diabetes remission in type 2 diabetic patients who do NOT meet NIH criteria for surgery and the role of soluble RAGE as a novel biomarker of success. Ann Surg. 2014;260:617–24.

    Article  PubMed  Google Scholar 

  15. Schauer PR, Bhatt DL, Kirwan JP, et al. Bariatric surgery versus intensive medical therapy for diabetes—5-year outcomes. N Engl J Med. 2017;376:641–51.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Simonson DC, Halperin F, Foster K, Vernon A, Goldfine AB. Clinical and patient-centered outcomes in obese patients with type 2 diabetes 3 years after randomization to Roux-en-Y gastric bypass surgery versus intensive lifestyle management: the SLIMM-T2D study. Diabetes Care. 2018;41:670–9.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Estimate of Bariatric Surgery Numbers, 2011-2020. In: American Society for Metabolic and Bariatric Surgery; 2022. https://asmbs.org/resources/estimate-of-bariatric-surgery-numbers. Accessed 31 Oct 2022.

  18. Rubino F, Forgione A, Cummings DE, Vix M, Gnuli D, Mingrone G, Castagneto M, Marescaux J. The mechanism of diabetes control after gastrointestinal bypass surgery reveals a role of the proximal small intestine in the pathophysiology of type 2 diabetes. Ann Surg. 2006;244:741. https://doi.org/10.1097/01.sla.0000224726.61448.1b.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Eisenberg D, Shikora SA, Aarts E, et al. 2022 American Society for Metabolic and Bariatric Surgery (ASMBS) and International Federation for the Surgery of obesity and metabolic disorders (IFSO): indications for metabolic and bariatric surgery. Surg Obes Relat Dis. 2022;18:1345. https://doi.org/10.1016/j.soard.2022.08.013.

    Article  PubMed  Google Scholar 

  20. Martinussen C, Bojsen-Møller KN, Dirksen C, Jacobsen SH, Jørgensen NB, Kristiansen VB, Holst JJ, Madsbad S. Immediate enhancement of first-phase insulin secretion and unchanged glucose effectiveness in patients with type 2 diabetes after Roux-en-Y gastric bypass. Am J Phys Endocrinol Metab. 2015;308:E535–44.

    Article  CAS  Google Scholar 

  21. Lingvay I, Guth E, Islam A, Livingston E. Rapid improvement in diabetes after gastric bypass surgery. Diabetes Care. 2013;36:2741–7.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Plourde C-É, Grenier-Larouche T, Caron-Dorval D, Biron S, Marceau S, Lebel S, Biertho L, Tchernof A, Richard D, Carpentier AC. Biliopancreatic diversion with duodenal switch improves insulin sensitivity and secretion through caloric restriction. Obesity. 2014;22:1838–46.

    Article  CAS  PubMed  Google Scholar 

  23. Manning S, Pucci A, Batterham RL. GLP-1: a mediator of the beneficial metabolic effects of bariatric surgery? Physiology (Bethesda). 2015;30:50–62.

    CAS  PubMed  Google Scholar 

  24. Jørgensen NB, Jacobsen SH, Dirksen C, et al. Acute and long-term effects of Roux-en-Y gastric bypass on glucose metabolism in subjects with type 2 diabetes and normal glucose tolerance. Am J Phys Endocrinol Metab. 2012;303:E122–31.

    Article  Google Scholar 

  25. Chen Y, Lu J, Nemati R, Plank LD, Murphy R. Acute changes of bile acids and FGF19 after sleeve gastrectomy and Roux-en-Y gastric bypass. Obes Surg. 2019;29:3605–21.

    Article  PubMed  Google Scholar 

  26. Ramzy AR, Nausheen S, Chelikani PK. Ileal transposition surgery produces ileal length-dependent changes in food intake, body weight, gut hormones and glucose metabolism in rats. Int J Obes. 2014;38:379–87.

    Article  CAS  Google Scholar 

  27. Manning S, Pucci A, Batterham RL. Roux-en-Y gastric bypass: effects on feeding behavior and underlying mechanisms. J Clin Invest. 2015;125:939–48.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Riddle MC, Cefalu WT, Evans PH, et al. Consensus report: definition and interpretation of remission in type 2 diabetes. Diabetes Care. 2021;44:2438–44.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  29. Castellana M, Procino F, Biacchi E, et al. Roux-en-Y gastric bypass vs sleeve gastrectomy for remission of type 2 diabetes. J Clin Endocrinol Metab. 2021;106:922–33.

    Article  PubMed  Google Scholar 

  30. Brethauer SA, Aminian A, Romero-Talamás H, et al. Can diabetes be surgically cured? Long-term metabolic effects of bariatric surgery in obese patients with type 2 diabetes mellitus. Ann Surg. 2013;258:628–37.

    Article  PubMed  Google Scholar 

  31. Mechanick JI, Apovian C, Brethauer S, et al. Clinical practice guidelines for the perioperative nutrition, metabolic, and nonsurgical support of patients undergoing bariatric procedures—2019 update: cosponsored by American Association of Clinical Endocrinologists/American College of Endocrinology, the Obesity Society, American Society for Metabolic & Bariatric Surgery, Obesity Medicine Association, and American Society of Anesthesiologists. Surg Obes Relat Dis. 2020;16:175. https://doi.org/10.1016/j.soard.2019.10.025.

    Article  PubMed  Google Scholar 

  32. Mechanick JI, Apovian C, Brethauer S, et al. CLINICAL PRACTICE GUIDELINES FOR THE PERIOPERATIVE NUTRITION, METABOLIC, AND NONSURGICAL SUPPORT OF PATIENTS UNDERGOING BARIATRIC PROCEDURES—2019 UPDATE: COSPONSORED BY AMERICAN ASSOCIATION OF CLINICAL ENDOCRINOLOGISTS/AMERICAN COLLEGE OF ENDOCRINOLOGY, THE OBESITY SOCIETY, AMERICAN SOCIETY FOR METABOLIC & BARIATRIC SURGERY, OBESITY MEDICINE ASSOCIATION, AND AMERICAN SOCIETY OF ANESTHESIOLOGISTS—EXECUTIVE SUMMARY. Endocr Pract. 2019;25:1346. https://doi.org/10.4158/GL-2019-0406.

    Article  PubMed  Google Scholar 

  33. Thourani VH, Weintraub WS, Stein B, Gebhart SSP, Craver JM, Jones EL, Guyton RA. Influence of diabetes mellitus on early and late outcome after coronary artery bypass grafting. Ann Thorac Surg. 1999;67:1045. https://doi.org/10.1016/S0003-4975(99)00143-5.

    Article  CAS  PubMed  Google Scholar 

  34. Frisch A, Chandra P, Smiley D, et al. Prevalence and clinical outcome of hyperglycemia in the perioperative period in noncardiac surgery. Diabetes Care. 2010;33:1783. https://doi.org/10.2337/dc10-0304.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  35. Thorell A, Efendic S, Gutniak M, Häggmark T, Ljungqvist O. Insulin resistance after abdominal surgery. Br J Surg. 1994;81:59. https://doi.org/10.1002/bjs.1800810120.

    Article  CAS  PubMed  Google Scholar 

  36. Blackstone R, Kieran J, Davis M, Rivera L. Continuous perioperative insulin infusion therapy for patients with type 2 diabetes undergoing bariatric surgery. Surg Endosc Other Interv Tech. 2007;21:1316. https://doi.org/10.1007/s00464-006-9100-0.

    Article  CAS  Google Scholar 

  37. Duggan EW, Carlson K, Umpierrez GE. Perioperative hyperglycemia management: an update. Anesthesiology. 2017;126:547. https://doi.org/10.1097/ALN.0000000000001515.

    Article  PubMed  Google Scholar 

  38. Datta S, Qaadir A, Villanueva G, Baldwin D. Once-daily insulin glargine versus 6-hour sliding scale regular insulin for control of hyperglycemia after a bariatric surgical procedure: a randomized clinical trial. Endocr Pract. 2007;13:225. https://doi.org/10.4158/EP.13.3.225.

    Article  PubMed  Google Scholar 

  39. Blackstone R, Kieran J, Davis M, Rivera L. Continuous perioperative insulin infusion therapy for patients with type 2 diabetes undergoing bariatric surgery. Surg Endosc. 2007;21:1316–22.

    Article  CAS  PubMed  Google Scholar 

  40. Wirunsawanya K, Chittimoju S, Fantasia KL, Modzelewski KL, Steenkamp D, Alexanian SM. Insulin requirements in patients with type 2 diabetes undergoing bariatric surgery in the inpatient setting and upon discharge: a single-center retrospective analysis of insulin management strategies. Endocr Pract. 2021;27:538. https://doi.org/10.1016/j.eprac.2020.12.014.

    Article  PubMed  Google Scholar 

  41. Diemer DM, Terry KL, Matthews M, Romich E, Saran H, Lansang MC. Postoperative insulin requirements in bariatric surgery. Endocr Pract. 2017;23:1369. https://doi.org/10.4158/EP171901.OR.

    Article  PubMed  Google Scholar 

  42. Rometo D, Korytkowski M. Perioperative glycemic Management of Patients Undergoing Bariatric Surgery. Curr Diab Rep. 2016;16:23. https://doi.org/10.1007/s11892-016-0718-6.

    Article  CAS  PubMed  Google Scholar 

  43. Thorell A, Hagström-Toft E. Treatment of diabetes prior to and after bariatric surgery. J Diabetes Sci Technol. 2012;6:1226. https://doi.org/10.1177/193229681200600528.

    Article  PubMed  PubMed Central  Google Scholar 

  44. Bettini S, Belligoli A, Fabris R, Busetto L. Diet approach before and after bariatric surgery. Rev Endocr Metab Disord. 2020;21:297. https://doi.org/10.1007/s11154-020-09571-8.

    Article  PubMed  PubMed Central  Google Scholar 

  45. Busetto L, Dicker D, Azran C, et al. Practical recommendations of the obesity management task force of the European Association for the Study of obesity for the post-bariatric surgery medical management. Obes Facts. 2018;10:597–632.

    Article  Google Scholar 

  46. Palacio AC, Quintiliano D, Vargas P, Cosentino M, Ríos MJ. Calorie and macronutrient intake during the first six months after bariatric surgery. Rev Med Chil. 2021;149:229. https://doi.org/10.4067/s0034-98872021000200229.

    Article  PubMed  Google Scholar 

  47. Aliakbarian H, Bhutta HY, Heshmati K, Unes Kunju S, Sheu EG, Tavakkoli A. Pre-operative predictors of weight loss and weight regain following Roux-en-Y gastric bypass surgery: a prospective human study. Obes Surg. 2020;30:4852. https://doi.org/10.1007/s11695-020-04877-7.

    Article  PubMed  Google Scholar 

  48. Miras AD, Pérez-Pevida B, Aldhwayan M, et al. Adjunctive liraglutide treatment in patients with persistent or recurrent type 2 diabetes after metabolic surgery (GRAVITAS): a randomised, double-blind, placebo-controlled trial. Lancet Diabetes Endocrinol. 2019;7:549. https://doi.org/10.1016/S2213-8587(19)30157-3.

    Article  CAS  PubMed  Google Scholar 

  49. Zelniker TA, Wiviott SD, Raz I, et al. SGLT2 inhibitors for primary and secondary prevention of cardiovascular and renal outcomes in type 2 diabetes: a systematic review and meta-analysis of cardiovascular outcome trials. Lancet. 2019;393:31. https://doi.org/10.1016/S0140-6736(18)32590-X.

    Article  CAS  PubMed  Google Scholar 

  50. Iqbal QZ, Mishiyev D, Niazi MR, Zia Z, Sattar SBA, Jahanghir A, Quyyumi S. SGLT-2 inhibitors—a culprit of diabetic ketoacidosis Postbariatric surgery. Case Rep Crit Care. 2020;2020:1–4.

    Article  Google Scholar 

  51. Iqbal QZ, Mishiyev D, Zia Z, Ruggiero RA, Aftab G. Euglycemic diabetic ketoacidosis with sodium-glucose Cotransporter-2 inhibitor use post-bariatric surgery: a brief review of the literature. Cureus. 2020;12:e10878. https://doi.org/10.7759/cureus.10878.

    Article  PubMed  PubMed Central  Google Scholar 

  52. Pilla SJ, Maruthur NM, Schweitzer MA, Magnuson TH, Potter JJ, Clark JM, Lee CJ. The role of laboratory testing in differentiating type 1 diabetes from type 2 diabetes in patients undergoing bariatric surgery. Obes Surg. 2018;28:25. https://doi.org/10.1007/s11695-017-2804-5.

    Article  PubMed  PubMed Central  Google Scholar 

  53. Fenske WK, Pournaras DJ, Aasheim ET, Miras AD, Scopinaro N, Scholtz S, le Roux CW. Can a protocol for glycaemic control improve type 2 diabetes outcomes after gastric bypass? Obes Surg. 2012;22:90. https://doi.org/10.1007/s11695-011-0543-6.

    Article  PubMed  Google Scholar 

  54. Jørgensen NB, Jacobsen SH, Dirksen C, et al. Acute and long-term effects of Roux-en-Y gastric bypass on glucose metabolism in subjects with type 2 diabetes and normal glucose tolerance. Am J Physiol Endocrinol Metab. 2012;303:E122–31.

    Article  PubMed  Google Scholar 

  55. Batterham RL, Cummings DE. Mechanisms of diabetes improvement following bariatric/metabolic surgery. Diabetes Care. 2016;39:893–901.

    Article  PubMed  PubMed Central  Google Scholar 

  56. Bojsen-Møller KN. Mechanisms of improved glycaemic control after Roux-en-Y gastric bypass. Dan Med J. 2015;62:B5057.

    PubMed  Google Scholar 

  57. Morey-Vargas OL, Aminian A, Steckner K, et al. Perioperative management of diabetes in patients undergoing bariatric and metabolic surgery: a narrative review and the Cleveland Clinic practical recommendations. Surg Obes Relat Dis. 2022;18:1087–101.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Section of Endocrinology, Diabetes, Nutrition and Weight Management, Boston University Chobanian & Avedisian School of Medicine, Boston Medical Center, Boston, MA, USA

    Jenny C. Bello-Ramos, Ivania M. Rizo & Sara M. Alexanian

Authors
  1. Jenny C. Bello-Ramos
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ivania M. Rizo
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Sara M. Alexanian
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Sara M. Alexanian .

Editor information

Editors and Affiliations

  1. Division of Endocrinology, Long Island Jewish Medical Center, Northwell Health, New Hyde Park, NY, USA

    Rifka C. Schulman-Rosenbaum

Rights and permissions

Reprints and permissions

Copyright information

© 2023 The Author(s), under exclusive license to Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Bello-Ramos, J.C., Rizo, I.M., Alexanian, S.M. (2023). Diabetes After Bariatric Surgery. In: Schulman-Rosenbaum, R.C. (eds) Diabetes Management in Hospitalized Patients. Contemporary Endocrinology. Springer, Cham. https://doi.org/10.1007/978-3-031-44648-1_22

Download citation

  • DOI: https://doi.org/10.1007/978-3-031-44648-1_22

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-031-44647-4

  • Online ISBN: 978-3-031-44648-1

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation