The Department of Endocrinology, 
Expert opinion on the preoperative medical optimization of adults with diabetes undergoing metabolic surgery.
- Endocrinology, Max Superspeciality Hospital, New Delhi 110092, India. saptarshi5@yahoo.com.
- Endocrinology, Bharti Hospital, Karnal 132001, Haryana, India.
- Endocrinology, Christian Medical College, Vellore 632004, Tamil Nadu, India.
- Endocrinology, Kalpavriksh Super Speciality Center, New Delhi 110075, India.
- Endocrinology, CEDAR Superspecialty Clinic, New Delhi 110075, India.
- Endocrinology, Apex Plus Superspeciality Hospital, Rohtak 124001, Haryana, India.
- Endocrinology, Maharaja Agrasen Hospital, New Delhi 110026, India.
- Endocrinology, Manipal Hospitals, New Delhi 110075, India.
- Endocrinology, Gangaram Bansal Super Speciality Hospital, Sri Ganganagar 335001, Rajasthan, India.
- Respiratory Medicine & Critical Care, Indraprastha Apollo Hospitals, Sarita Vihar, New Delhi 110076, India.
- Endocrinology, Gandhi Medical College, Bhopal 462001, Madhya Pardesh, India.
- Endocrinology, Apollo Hospitals, Guwahati 781005, Assam, India.
- Minimal Access, Metabolic and Bariatric surgery, Max Superspeciality Hospital, Patparganj, New Delhi 110092, India.
- Nutrition, Max Superspeciality Hospital, Patparganj, New Delhi 110092, India.
World journal of diabetes Vol. 12 · Issue 10 · pp. 1587-1621
PMID 34754367 DOI 10.4239/wjd.v12.i10.1587
Cite This Article
Saptarshi Bhattacharya, Sanjay Kalra, Nitin Kapoor, Rajiv Singla, Deep Dutta, Sameer Aggarwal, Deepak Khandelwal, Vineet Surana, Atul Dhingra, Viny Kantroo, Sachin Chittawar, Nilakshi Deka, Vivek Bindal, Puja Dutta. Expert opinion on the preoperative medical optimization of adults with diabetes undergoing metabolic surgery. World journal of diabetes. 2021;12(10):1587-1621. doi:10.4239/wjd.v12.i10.1587
Abstract
Diabetes mellitus (DM) and obesity are interrelated in a complex manner, and their coexistence predisposes patients to a plethora of medical problems. Metabolic surgery has evolved as a promising therapeutic option for both conditions. It is recommended that patients, particularly those of Asian origin, maintain a lower body mass index threshold in the presence of uncontrolled DM. However, several comorbidities often accompany these chronic diseases and need to be addressed for successful surgical outcome. Laparoscopic Roux-en-Y gastric bypass (RYGB) and laparoscopic sleeve gastrectomy (LSG) are the most commonly used bariatric procedures worldwide. The bariatric benefits of RYGB and LSG are similar, but emerging evidence indicates that RYGB is more effective than LSG in improving glycemic control and induces higher rates of long-term DM remission. Several scoring systems have been formulated that are utilized to predict the chances of remission. A glycemic target of glycated hemoglobin < 7% is a reasonable goal before surgery. Cardiovascular, pulmonary, gastrointestinal, hepatic, renal, endocrine, nutritional, and psychological optimization of surgical candidates improves perioperative and long-term outcomes. Various guidelines for preoperative care of individuals with obesity have been formulated, but very few specifically focus on the concerns arising from the presence of concomitant DM. It is hoped that this statement will lead to the standardization of presurgical management of individuals with DM undergoing metabolic surgery.
Keywords
- Bariatric surgery
- Diabetes
- Metabolic surgery
- Obesity
- Remission of diabetes
