title: Impact of perioperative management of glycemia in severely obese diabetic patients undergoing gastric bypass surgery.
abstract: BACKGROUND
  Roux-en-Y gastric bypass (RYGB) surgery is associated with rapid postsurgical improvement in glycemic control in patients with type 2 diabetes mellitus (T2 DM). However, there is little outcome-based evidence to guide the glycemic management of this patient group preoperatively.
  
  
  OBJECTIVE
  We conducted 2 pilot studies randomizing patients to assess the impact of intensive glucose management pre- and post-RYGB on clinical outcomes after surgery.
  
  
  METHODS
  University hospital.
  
  
  METHODS
  In the GLUCOSURG-pre randomized controlled trial (RCT), 34 obese T2 DM patients with glycated hemoglobin (HbA1 c) ≥8.5% (69 mmol/mol) undergoing RYGB were randomly assigned to receive either glucose optimization or no optimization 3 months preoperatively. In the GLUCOSURG-post RCT, 35 obese T2 DM patients on insulin were randomly assigned to either intensive or conservative glucose management up to 2 weeks post- RYGB. HbA1c at 1 year post-RYGB was the primary outcome.
  
  
  RESULTS
  In GLUCOSURG-pre, the HbA1 c at 1 year postsurgery was -3.0% (51.9 mmol/mol) in the optimized and -4.0% (45.4 mmol/mol) in the nonoptimized groups (P = .06). In GLUCOSURG-post, there were no significant differences in HbA1 c at 1 year postsurgery between the intensive and conservative groups [-2.4% (44.3 mmol/mol)] versus [-2.3% (44.3 mmol/mol), P = .73)].
  
  
  CONCLUSIONS
  Our pilot studies suggested that neither intensive management of glycemia in the 3 months pre- RYGB, nor the first 2 weeks post-RYGB resulted in better glycemic control one year after surgery. RYGB has substantial effects on glucose control, and additional intensive glucose-lowering interventions do not confer clinical benefits compared to conservative approaches.
authors: Metabolic Medicine Research Unit, Imperial College London, United Kingdom. Electronic address: llchuah@gmail.com.
authors: Ling L
authors: LL
authors: Chuah
authors: Metabolic Medicine Research Unit, Imperial College London, United Kingdom.
authors: Alexander D
authors: AD
authors: Miras
authors: Metabolic Medicine Research Unit, Imperial College London, United Kingdom.
authors: Dimitris
authors: D
authors: Papamargaritis
authors: Metabolic Medicine Research Unit, Imperial College London, United Kingdom.
authors: Sabina N
authors: SN
authors: Jackson
authors: Metabolic Medicine Research Unit, Imperial College London, United Kingdom; Gastro Surgical Laboratory, University of Gothenburg, Sweden.
authors: Torsten
authors: T
authors: Olbers
authors: Metabolic Medicine Research Unit, Imperial College London, United Kingdom; Gastro Surgical Laboratory, University of Gothenburg, Sweden; Diabetes Complications Research Center, Conway Institute, University College Dublin, Ireland.
authors: Carel W
authors: CW
authors: le Roux
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001786:Blood Glucose / Q000378:metabolism*; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000150:complications / Q000188:drug therapy*; D005260:Female; D005500:Follow-Up Studies; D015390:Gastric Bypass; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000150:complications / Q000601:surgery*; D011300:Preoperative Care / Q000379:methods*; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D001786:Blood Glucose; D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents
keywords: Gastric bypass; Glucose management; Postoperative; Preoperative; Type 2 diabetes