CHU Montpellier, Centre d'Investigation Clinique et Département des Maladies Endocriniennes, Inserm, CIC 1411, Hôpital St Éloi, 90, avenue Augustin-Fliche, 34295 Montpellier cedex 05, France.
University of Lille, CHU Lille Endocrine and Metabolic Surgery, Inserm UMR 1190 Translational Research for Diabetes, 2, avenue Oscar-Lambret, 59000 Lille, France.
J Visc Surg. 2020 Feb;157(1):13-21. doi: 10.1016/j.jviscsurg.2019.07.012. Epub 2019 Aug 7.
Metabolic surgery is now considered as a therapeutic option in type 2 diabetes (T2D). However, few data are available regarding perioperative management of T2D.
To assess current practice among bariatric teams regarding perioperative management of T2D in order to propose guidelines.
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.
A total of 170 experts participated. Experts favored gastric bypass to achieve remission (76.7%). Screening for retinopathy, cardiac ultrasound, and reaching an HbA<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%).
Rapid postoperative modifications of blood glucose require a close monitoring and a prompt adjustment of diabetes medications.
代谢手术目前被认为是 2 型糖尿病（T2D）的一种治疗选择。然而，关于 T2D 的围手术期管理，可用的数据很少。
评估减重外科团队在 T2D 围手术期管理方面的当前实践，以提出指导方针。
采用两轮在线调查的 Delphi 方法，对减重外科团队的专家（外科医生、糖尿病专家、麻醉师、营养师）进行调查：第一轮包括 63 个问题，涵盖 6 个主题（专家/团队特征、患者特征、手术技术、围手术期管理、糖尿病缓解）；第二轮包括 44 个需要澄清的项目。这些问题在相应的学会全国大会上进行了讨论。共识定义为≥66%的同意率。
共有 170 名专家参与。专家倾向于选择胃旁路术来实现缓解（76.7%）。在术前，67%、75.3%和 56.7%的专家分别要求筛查视网膜病变、心脏超声和达到 HbA<8%。手术后，胰岛素泵不应停用，基础胰岛素应减半，仅在严重高血糖时才停止使用胰岛素冲击治疗。手术后，建议使用 DPP-IV 抑制剂和二甲双胍。如果患者服用口服降糖药，应在一个月内（71.8%的专家），如果使用注射治疗，应在两周内（77.1%的专家），如果使用胰岛素泵，应在手术后立即（93.5%的专家）由糖尿病专家进行检查。即使糖尿病缓解，也需要长期监测 HbA1c（100%）。
血糖的快速术后变化需要密切监测和及时调整糖尿病药物。
