Bariatric surgery and the perioperative management of type 2 diabetes: Practical guidelines

被引：5

作者：

Galtier, F. ^{[1
,2
]}

Pattou, F. ^{[3
]}

Czernichow, S. ^{[4
,5
,6
]}

Disse, E. ^{[7
]}

Ritz, P. ^{[8
]}

Chevallier, J-M ^{[9
,10
]}

Cosson, E. ^{[11
,12
]}

Valensi, P. ^{[11
]}

Andreelli, F. ^{[13
,14
]}

Robert, M. ^{[7
,14
,15
]}

Fabrizio, Andreelli ^{[13
,14
]}

Raymond, Arnoux ^{[16
]}

Pierre, Campan ^{[17
]}

Bertrand, Cariou ^{[18
]}

Jean-Marc, Chevallier ^{[10
,19
]}

Sebastien, Czernichow ^{[4
,5
,6
]}

Emmanuel, Disse ^{[7
]}

Pierre, Fontaine ^{[20
,23
]}

Florence, Galtier ^{[21
,22
]}

Jean, Gugenheim ^{[24
,25
]}

Gilles, Lebuffe ^{[20
]}

Pascale, Martini ^{[26
]}

Laurent, Meyer

Francois, Pattou ^{[3
]}

Patrick, Ritz ^{[8
]}

Maud, Robert ^{[27
]}

Maxime, Sodji

Philippe, Topart

Paul, Valensi ^{[28
]}

Michel, Vix

机构：

[1] CHU Montpellier, Hop St Eloi, Ctr Invest Clin, Inserm,CIC 1411, 90 Ave Augustin Fliche, F-34295 Montpellier 05, France

[2] CHU Montpellier, Hop St Eloi, Dept Malad Endocriniennes, Inserm,CIC 1411, 90 Ave Augustin Fliche, F-34295 Montpellier 05, France

[3] Univ Lille, CHU Lille Endocrine & Metab Surg, Inserm UMR Translat Res Diabet 1190, 2 Ave Oscar Lambret, F-59000 Lille, France

[4] Hop Europeen Georges Pompidou, AP HP, Dept Nutr, Ctr Specialise Obesite Ile de France Sud, 20 Rue Leblanc, F-75015 Paris, France

[5] Univ Paris 05, 20 Rue Leblanc, F-75015 Paris, France

[6] INSERM, UMR Epidemiol & Biostat 1153, Sorbonne Paris Cite Ctr, METHODS Team, 20 Rue Leblanc, F-75015 Paris, France

[7] Univ Lyon 1, Federat Hosp Univ DO IT, Ctr Integre & Specialise Obesite Lyon, CRNH RA,Hosp Civils Lyon, 165 Chemin Grand Revoyet, F-69310 Pierre Benite, France

[8] Univ Paul Sabatier, CHU Toulouse, Inserm U1027, Ctr Integre Obesite, Route Narbonne, F-31330 Toulouse, France

[9] Hop Europeen Georges Pompidou, AP HP, Ctr Specialise Obesite Ile France Sud, Dept Digest Surg, 20 Rue Leblanc, F-75015 Paris, France

[10] Univ Paris 05, 20 Rue Leblanc, F-75015 Paris, France

[11] Paris 13 Univ, Hop Jean Verdier, AP HP, Sorbonne Paris Cite,CRNH IdF,CINFO,Dept Endocrino, Ave 14 Juillet, F-93140 Bondy, France

[12] Paris 13 Univ, Sorbonne Paris Cite, CNAM, UMR U1153,Inserm,U1125,Inra, 74 Rue Marcel Cachin, F-93017 Bobigny, France

[13] Hop La Pitie Salpetriere, AP HP, Heart & Metab Dept, Cardiometab & Nutr Inst ICAN, 47-83 Blvd Hop, F-75013 Paris, France

[14] Sorbonne Univ, UPMC, INSERM UMRS U1166, Eq 6 Nutri,Pierre & Marie Curie Fac Paris 6, 91 & 105,Blvd Hop, F-75013 Paris, France

[15] Hosp Civils Lyon, Hosp Edouard Herriot, Ctr Bariatr Surg, Dept Digest Surg, Lyon, France

[16] Polyclin Tondu, Ctr Chirurg Obesite & Diabete, 151 Rue Tondu, F-33000 Bordeaux, France

[17] Hop Conception, AP HM, Serv Chirurg Gen & Metabol, Marseille, France

[18] CHU Nantes, Inst Thorax, Dept Endocrinol, Nantes, France

[19] Hop Europeen Georges Pompidou, AP HP, Dept Digest Surg, Ctr Specialise Obesite Ile de France Sud, Paris, France

[20] CHU Lille, Lille, France

[21] CHU Montpellier, Ctr Invest Clin, Montpellier, France

[22] CHU Montpellier, Dept Malad Endocriniennes, Montpellier, France

[23] INSERM, CIC 1411, Montpellier, France

[24] Hop Archet II, Dept Digest Surg, 151 Route St Antoine Ginestiere, F-06202 Nice 3, France

[25] Hop Archet II, Serv Chirurg Digest, Ctr Liver Transplantat, 151 Route St Antoine Ginestiere, F-06202 Nice 3, France

[26] CHU Toulouse, Hop Rangueil, Serv Diabetol Malad Metabol Nutr, Toulouse, France

[27] Univ Lyon 1, Federat Hosp Univ DO IT, Hosp Edouard Herriot,Ctr Integre & Specialise Obe, Dept Digest Surg,Ctr Bariatr Surg,CRNH RA,Hosp Ci, Lyon, France

[28] Paris 13 Univ, Sorbonne Paris Cite, Hop Jean Verdier, AP HP,CRNH IdF,CINFO,Dept Endocrinol,Diabetol & N, F-93140 Bondy, France

来源：

JOURNAL OF VISCERAL SURGERY | 2020年 / 157卷 / 01期

关键词：

Metabolic surgery; Diabetes; Guidelines; Bariatric surgery; GLUCOSE-METABOLISM; GASTRIC BYPASS; THERAPY;

D O I：

10.1016/j.jviscsurg.2019.07.012

中图分类号：

R61 [外科手术学];

学科分类号：

摘要：

Background: Metabolic surgery is now considered as a therapeutic option in type 2 diabetes (T2D). However, few data are available regarding perioperative management of T2D. Objectives: To assess current practice among bariatric teams regarding perioperative management of T2D in order to propose guidelines. Methods: A two-round Delphi method using online surveys was employed among bariatric teams experts (surgeons, diabetologists, anesthetists, nutritionists): first round, 63 questions covering 6 topics (characteristics of experts/teams, characteristics of patients, operative technique, pre/postoperative management, diabetes remission); second round, 44 items needing clarification. They were discussed within national congress of corresponding learned societies. Consensus was defined as >= 66% agreement. Results: A total of 170 experts participated. Experts favored gastric bypass to achieve remission (76.7%). Screening for retinopathy, cardiac ultrasound, and reaching an HbA(1c) < 8% are required in the pre-operative period for 67%, 75.3% and 56.7% of experts, respectively. After surgery, insulin pump should not be stopped, basal insulin should be halved, and bolus insulin should be stopped except if severe hyperglycemia. DPP-IV inhibitors and metformin are preferred after surgery. Patients should be seen by a diabetologist within one month if on oral antidiabetic agents (71.8% of experts), 2 weeks if on injectable treatments (77.1% of experts), and immediately after surgery if on insulin pump (93.5% of experts). Long-term monitoring of HbA1c is necessary even if diabetes remission (100%). Conclusion: Rapid postoperative modifications of blood glucose require a close monitoring and a prompt adjustment of diabetes medications. (C) 2019 Elsevier Masson SAS. All rights reserved.

引用

页码：13 / 21

页数：9

共 17 条

[1]

[Anonymous], OBESITY S1

[2] Practical Recommendations of the Obesity Management Task Force of the European Association for the Study of Obesity for the Post-Bariatric Surgery Medical Management [J].