PMID- 25863535
OWN - NLM
STAT- MEDLINE
DCOM- 20160419
LR  - 20221207
IS  - 1878-7533 (Electronic)
IS  - 1550-7289 (Linking)
VI  - 11
IP  - 3
DP  - 2015 May-Jun
TI  - Impact of perioperative management of glycemia in severely obese diabetic 
      patients undergoing gastric bypass surgery.
PG  - 578-84
LID - S1550-7289(14)00427-4 [pii]
LID - 10.1016/j.soard.2014.11.004 [doi]
AB  - 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 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.
CI  - Copyright (c) 2015 American Society for Bariatric Surgery. Published by Elsevier 
      Inc. All rights reserved.
FAU - Chuah, Ling L
AU  - Chuah LL
AD  - Metabolic Medicine Research Unit, Imperial College London, United Kingdom. 
      Electronic address: llchuah@gmail.com.
FAU - Miras, Alexander D
AU  - Miras AD
AD  - Metabolic Medicine Research Unit, Imperial College London, United Kingdom.
FAU - Papamargaritis, Dimitris
AU  - Papamargaritis D
AD  - Metabolic Medicine Research Unit, Imperial College London, United Kingdom.
FAU - Jackson, Sabina N
AU  - Jackson SN
AD  - Metabolic Medicine Research Unit, Imperial College London, United Kingdom.
FAU - Olbers, Torsten
AU  - Olbers T
AD  - Metabolic Medicine Research Unit, Imperial College London, United Kingdom; Gastro 
      Surgical Laboratory, University of Gothenburg, Sweden.
FAU - le Roux, Carel W
AU  - le Roux CW
AD  - 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.
LA  - eng
GR  - G0902002/MRC_/Medical Research Council/United Kingdom
PT  - Journal Article
PT  - Randomized Controlled Trial
PT  - Research Support, Non-U.S. Gov't
DEP - 20141113
PL  - United States
TA  - Surg Obes Relat Dis
JT  - Surgery for obesity and related diseases : official journal of the American 
      Society for Bariatric Surgery
JID - 101233161
RN  - 0 (Blood Glucose)
RN  - 0 (Glycated Hemoglobin A)
RN  - 0 (Hypoglycemic Agents)
SB  - IM
MH  - Adolescent
MH  - Adult
MH  - Aged
MH  - Blood Glucose/*metabolism
MH  - Diabetes Mellitus, Type 2/blood/complications/*drug therapy
MH  - Female
MH  - Follow-Up Studies
MH  - *Gastric Bypass
MH  - Glycated Hemoglobin/metabolism
MH  - Humans
MH  - Hypoglycemic Agents/*therapeutic use
MH  - Male
MH  - Middle Aged
MH  - Obesity, Morbid/complications/*surgery
MH  - Preoperative Care/*methods
MH  - Retrospective Studies
MH  - Treatment Outcome
MH  - Young Adult
OTO - NOTNLM
OT  - Gastric bypass
OT  - Glucose management
OT  - Postoperative
OT  - Preoperative
OT  - Type 2 diabetes
EDAT- 2015/04/13 06:00
MHDA- 2016/04/20 06:00
CRDT- 2015/04/13 06:00
PHST- 2014/05/13 00:00 [received]
PHST- 2014/10/25 00:00 [revised]
PHST- 2014/11/03 00:00 [accepted]
PHST- 2015/04/13 06:00 [entrez]
PHST- 2015/04/13 06:00 [pubmed]
PHST- 2016/04/20 06:00 [medline]
AID - S1550-7289(14)00427-4 [pii]
AID - 10.1016/j.soard.2014.11.004 [doi]
PST - ppublish
SO  - Surg Obes Relat Dis. 2015 May-Jun;11(3):578-84. doi: 10.1016/j.soard.2014.11.004. 
      Epub 2014 Nov 13.