PMID- 29722910
OWN - NLM
STAT- MEDLINE
DCOM- 20190322
LR  - 20190322
IS  - 1875-9114 (Electronic)
IS  - 0277-0008 (Linking)
VI  - 38
IP  - 6
DP  - 2018 Jun
TI  - Glycemic Management in the Bariatric Surgery Population: A Review of the 
      Literature.
PG  - 663-673
LID - 10.1002/phar.2120 [doi]
AB  - Obesity is a worldwide epidemic often complicated by multiple comorbidities, 
      including type 2 diabetes mellitus (T2DM). Bariatric surgery is an increasingly 
      common and effective weight-loss strategy for obese patients that may result in 
      resolution of metabolic-related disease states, such as T2DM. Although bariatric 
      surgery has many positive outcomes for patients, dietary and pathophysiologic 
      changes can create difficult-to-control blood glucose, especially in the 
      immediate perioperative setting. Depending on oral antidiabetic agent and insulin 
      needs preoperatively, many patients require cessation of oral agents and 
      reduction or cessation of insulin. Unfortunately, despite available perioperative 
      bariatric surgery guidelines, no specific recommendations for perioperative oral 
      antidiabetic agent or insulin management exist. The purpose of this article is to 
      review the current body of evidence for blood glucose management in the setting 
      of bariatric surgery. An English-language PubMed and MEDLINE search was conducted 
      from 1964 through March 2018 using the following search terms alone and in 
      various combinations: bariatric surgery, gastric banding, laparoscopic sleeve 
      gastrectomy (LSG), Roux-en-Y gastric bypass (RYGB), glucose management, insulin, 
      and oral antidiabetic agent. Five articles were identified evaluating insulin 
      management in the perioperative bariatric surgery setting, which were separated 
      into two categories: immediate perioperative insulin management and long-term 
      postoperative insulin management. Overall, various blood glucose management 
      insulin protocols were evaluated. All studies included some type of insulin 
      reduction in the perioperative setting. No studies identified specifically 
      evaluated down-titration or discontinuation of oral antidiabetic agents. Given 
      the lack of specific guideline recommendations, limitations of standardized 
      insulin protocols, and inconsistency of outcomes studied, perioperative insulin 
      at reduced doses compared to previous maintenance doses coupled with frequent 
      blood glucose monitoring is reasonable. An opportunity exists for successful 
      protocols to be addressed in future, larger studies.
CI  - (c) 2018 Pharmacotherapy Publications, Inc.
FAU - Howard, Meredith L
AU  - Howard ML
AUID- ORCID: 0000-0003-4514-3948
AD  - Department of Pharmacotherapy, University of North Texas System College of 
      Pharmacy, Fort Worth, Texas.
FAU - Steuber, Taylor D
AU  - Steuber TD
AD  - Department of Pharmacy Practice, Auburn University Harrison School of Pharmacy, 
      Huntsville, Alabama.
FAU - Nisly, Sarah A
AU  - Nisly SA
AUID- ORCID: 0000-0002-1370-4694
AD  - Wingate University School of Pharmacy, Wingate, North Carolina.
LA  - eng
PT  - Journal Article
PT  - Review
PL  - United States
TA  - Pharmacotherapy
JT  - Pharmacotherapy
JID - 8111305
RN  - 0 (Blood Glucose)
RN  - 0 (Insulin)
SB  - IM
MH  - *Bariatric Surgery
MH  - Blood Glucose/*analysis
MH  - Diabetes Mellitus, Type 2/blood/*drug therapy
MH  - Humans
MH  - Insulin/*therapeutic use
MH  - Perioperative Care
MH  - Postoperative Care
OTO - NOTNLM
OT  - bariatric surgery
OT  - blood glucose management
OT  - insulin
OT  - perioperative
EDAT- 2018/05/04 06:00
MHDA- 2019/03/23 06:00
CRDT- 2018/05/04 06:00
PHST- 2018/05/04 06:00 [pubmed]
PHST- 2019/03/23 06:00 [medline]
PHST- 2018/05/04 06:00 [entrez]
AID - 10.1002/phar.2120 [doi]
PST - ppublish
SO  - Pharmacotherapy. 2018 Jun;38(6):663-673. doi: 10.1002/phar.2120.