Abstract
BackgroundRoux-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. MethodsIn 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. ResultsIn 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)]. ConclusionsOur 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.
Published Version
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