Metabolic Surgery Postoperative Follow-Up for Type 2 Diabetes Guidelines | NDEI

  • The 2nd Diabetes Surgery Summit (DSS-II), an international consensus conference, convened with international diabetes organizations to develop global guidelines for the use of metabolic (bariatric) surgery for the treatment of type 2 diabetes.
  • This slide reviews the postoperative follow-up recommendations for type 2 diabetes patients after metabolic/bariatric surgery.
  • Patients should continue to be managed by a multidisciplinary team.
  • Surgical and nutritional evaluations should be conducted at least every 6 months during the first 2 postoperative years, and at least annually thereafter.
  • Glycemic control should be monitored frequently to avoid potential hyperglycemia relapse.
  • If stable normoglycemia for at least 6 months: monitor glycemic control. If normoglycemic (remission) for 5 years, monitoring frequency can be reduced. Complete cessation of screening for a complication should be considered only if normoglycemia persists and there is no history for the complication.
  • Within the first 6 months after surgery, patients should be evaluated for glycemic control and antidiabetes medication(s) tapered. After 6 months, patients should be dosed accordingly, but not discontinued until stable normoglycemia for at least two 3-month 1c cycles. Withdrawal of certain frontline medications (e.g., metformin) should be considered more carefully.
  • In the event of plasma glucose levels rapidly approaching normal range early postoperatively, appropriate adjustments of medication types and dosage should be implemented to prevent hypoglycemia. Metformin, TZDs, GLP-1 receptor agonists, DPP-4 inhibitors, alpha-glucosidase inhibitors, and SGLT2 inhibitors are suitable for early postoperative diabetes management.
  • Ongoing and long-term monitoring of micronutrient status, nutritional supplementation, and patient support must be provided.

Rubino F, Nathan DM, Eckel RH, et al. Metabolic surgery in the treatment algorithm for type 2 diabetes: a joint statement by international diabetes organizations. Diabetes Care. 2016;39:861-877.

June 2016