Premium
Clinical considerations for the management of residual diabetes following bariatric surgery
Author(s) -
Kashyap S. R.,
Schauer P.
Publication year - 2012
Publication title -
diabetes, obesity and metabolism
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.445
H-Index - 128
eISSN - 1463-1326
pISSN - 1462-8902
DOI - 10.1111/j.1463-1326.2012.01577.x
Subject(s) - medicine , gastric banding , diabetes mellitus , weight loss , sleeve gastrectomy , surgery , gastric bypass , type 2 diabetes , insulin resistance , gastric bypass surgery , intensive care medicine , insulin , obesity , endocrinology
Residual diabetes following bariatric surgery is increasingly recognized despite initial weight loss. It occurs more commonly following banding and sleeve gastrectomy procedures than with gastric bypass, is associated with long duration and advanced stages of diabetes and is exacerbated by weight regain. Long‐term diabetes management following various gastric restrictive surgery (i.e. lap banding) requires targeting weight loss, insulin resistance and insulin secretion defects with antidiabetic agents that have weight negative or neutral effects. In contrast, re‐emergence of hyperglycaemia following gastric bypass may require targeting β ‐cell failure with insulin analogues. Revisional bariatric surgery is also a consideration. On the basis of our experience, we propose a clinical approach for long‐term management of diabetes following various bariatric procedures in the presence and absence of weight regain that is based on recognized pathophysiological effects of these procedures on diabetes remission.