Diabetes management in people undergoing metabolic-bariatric surgery: A guideline from the Joint British Diabetes Societies for Inpatient Care (JBDS-IP) Group - PubMed
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- Metabolic-bariatric surgery is effective for obesity and type 2 diabetes, offering potential remission and improved glycaemic control.
- Guidelines recommend pre-operative glycaemic optimisation with HbA1c <69 mmol/mol (<8.5%) where safe.
- Multidisciplinary care and individualised treatment plans are emphasised for optimal outcomes.
- For type 2 diabetes, certain medications like metformin and GLP-1 based therapies can continue during the liver reduction diet (LRD), while others like sulfonylureas should be discontinued to avoid hypoglycaemia.
- Insulin doses for type 2 diabetes should be reduced by 35%-50% during LRD and adjusted post-operatively.
- For type 1 diabetes, insulin must never be stopped to prevent diabetic ketoacidosis (DKA), requiring careful planning with diabetes teams.
- Post-operative care includes regular glucose monitoring, hypoglycaemia surveillance, and follow-up with diabetes specialists.