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Göteborgs universitets publikationer

Impact of perioperative management of glycemia in severely obese diabetic patients undergoing gastric bypass surgery

Författare och institution:
L. L. Chuah (-); A. D. Miras (-); D. Papamargaritis (-); S. N. Jackson (-); Torsten Olbers (Institutionen för kliniska vetenskaper, sektionen för kirurgi och kirurgisk gastroforskning, Avdelningen för gastrokirurgisk forskning och utbildning); Carel W le Roux (Institutionen för kliniska vetenskaper, sektionen för kirurgi och kirurgisk gastroforskning, Avdelningen för gastrokirurgisk forskning och utbildning)
Publicerad i:
Surgery for Obesity and Related Diseases, 11 ( 3 ) s. 578-584
Artikel, refereegranskad vetenskaplig
Sammanfattning (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. Objectives: We conducted 2 pilot studies randomizing patients to assess the impact of intensive glucose management pre- and post-RYGB on clinical outcomes after surgery. Setting: 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 postsurgely 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. (C) 2015 American Society for Metabolic and Bariatric Surgery. All rights reserved.
Ämne (baseras på Högskoleverkets indelning av forskningsämnen):
Klinisk medicin ->
Gastric bypass, Type 2 diabetes, Preoperative, Postoperative, Glucose management, BARIATRIC SURGERY, HEMOGLOBIN A1C, OUTCOMES, HYPERGLYCEMIA, MELLITUS, PREDICTOR, Surgery
Postens nummer:
Posten skapad:
2015-08-06 10:26
Posten ändrad:
2015-09-30 10:52

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