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Perioperative Management of Medical Comorbidities After Bariatric Surgery

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Abstract

With evolution, we have moved away from the concept of ‘bariatric surgery’ towards the present concept of ‘metabolic surgery’ where we look beyond just weight loss [1]. Recent evidences from literature clearly shows that the surgical remission of type 2 diabetes mellitus (T2DM) is now possible in the long term without the need for medications [2, 3]. It has also been shown that the reduction in medications post bariatric surgery has a significant economic benefit with reduction of medication costs required for the treatment of diabetes, hypertension and dyslipidemia [4]. This surgical concept of treatment of diabetes has been endorsed by many diabetic associations including the International Diabetic Federation [5].

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References

  1. Hickey MS, Pories WJ, MacDonald KG, Cory KA, Dohm GL, Swanson MS, et al. A new paradigm for type 2 diabetes mellitus: could it be a disease of the foregut? Ann Surg. 1998;227(5):637–43; discussion 643–4.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  2. Brethauer SA, Aminian A, Romero-Talamás H, Batayyah E, Mackey J, Kennedy L, et al. Can diabetes be surgically cured? Long-term metabolic effects of bariatric surgery in obese patients with type 2 diabetes mellitus. Ann Surg. 2013;258(4):628–36; discussion 636–7.

    PubMed  PubMed Central  Google Scholar 

  3. Lee W-J, Hur KY, Lakadawala M, Kasama K, Wong SKH, Lee Y-C. Gastrointestinal metabolic surgery for the treatment of diabetic patients: a multi-institutional international study. J Gastrointest Surg Off J Soc Surg Aliment Tract. 2012;16(1):45–51; discussion 51–2.

    Article  Google Scholar 

  4. Nguyen NT, Varela JE, Sabio A, Naim J, Stamos M, Wilson SE. Reduction in prescription medication costs after laparoscopic gastric bypass. Am Surg. 2006;72(10):853–6.

    PubMed  Google Scholar 

  5. Dixon JB, Zimmet P, Alberti KG, Rubino F. International diabetes federation taskforce on epidemiology and prevention. Bariatric surgery: an IDF statement for obese type 2 diabetes. Arq Bras Endocrinol Metabol. 2011;55(6):367–82.

    Article  CAS  PubMed  Google Scholar 

  6. Fenske WK, Pournaras DJ, Aasheim ET, Miras AD, Scopinaro N, Scholtz S, et al. Can a protocol for glycaemic control improve type 2 diabetes outcomes after gastric bypass? Obes Surg. 2012;22(1):90–6.

    Article  PubMed  Google Scholar 

  7. American Diabetes Association. Standards of medical care in diabetes – 2012. Diabetes Care. 2012;35 Suppl 1:S11–63.

    Google Scholar 

  8. Buchwald H, Avidor Y, Braunwald E, Jensen MD, Pories W, Fahrbach K, et al. Bariatric surgery: a systematic review and meta-analysis. JAMA. 2004;292(14):1724–37.

    Article  CAS  PubMed  Google Scholar 

  9. Hall TC, Pellen MGC, Sedman PC, Jain PK. Preoperative factors predicting remission of type 2 diabetes mellitus after Roux-en-Y gastric bypass surgery for obesity. Obes Surg. 2010;20(9):1245–50.

    Article  PubMed  Google Scholar 

  10. Buchwald H, Estok R, Fahrbach K, Banel D, Jensen MD, Pories WJ, et al. Weight and type 2 diabetes after bariatric surgery: systematic review and meta-analysis. Am J Med. 2009;122(3):248–56. e5.

    Article  PubMed  Google Scholar 

  11. Action to Control Cardiovascular Risk in Diabetes Study Group; Gerstein HC, Miller ME, Byington RP, Goff DC, Bigger JT, et al. Effects of intensive glucose lowering in type 2 diabetes. N Engl J Med. 2008;358(24):2545–59.

    Google Scholar 

  12. Duckworth W, Abraira C, Moritz T, Reda D, Emanuele N, Reaven PD, et al. Glucose control and vascular complications in veterans with type 2 diabetes. N Engl J Med. 2009;360(2):129–39.

    Article  CAS  PubMed  Google Scholar 

  13. Sjöström L, Peltonen M, Jacobson P, Ahlin S, Andersson-Assarsson J, Anveden Å, et al. Association of bariatric surgery with long-term remission of type 2 diabetes and with microvascular and macrovascular complications. JAMA. 2014;311(22):2297–304.

    Article  PubMed  Google Scholar 

  14. Pernicova I, Korbonits M. Metformin – mode of action and clinical implications for diabetes and cancer. Nat Rev Endocrinol. 2014;10(3):143–56.

    Article  CAS  PubMed  Google Scholar 

  15. Padwal RS, Gabr RQ, Sharma AM, Langkaas L-A, Birch DW, Karmali S, et al. Effect of gastric bypass surgery on the absorption and bioavailability of metformin. Diabetes Care. 2011;34(6):1295–300.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  16. Khanna V, Kashyap SR. Clinical management of type 2 diabetes mellitus after bariatric surgery. Curr Atheroscler Rep. 2015;17(10):59.

    Article  PubMed  Google Scholar 

  17. Kahn SE, Cooper ME, Del Prato S. Pathophysiology and treatment of type 2 diabetes: perspectives on the past, present, and future. Lancet Lond Engl. 2014;383(9922):1068–83.

    Article  CAS  Google Scholar 

  18. Bennett WL, Maruthur NM, Singh S, Segal JB, Wilson LM, Chatterjee R, et al. Comparative effectiveness and safety of medications for type 2 diabetes: an update including new drugs and 2-drug combinations. Ann Intern Med. 2011;154(9):602–13.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Gupta V. Glucagon-like peptide-1 analogues: an overview. Indian J Endocrinol Metab. 2013;17(3):413–21.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  20. Habegger KM, Kirchner H, Yi C-X, Heppner KM, Sweeney D, Ottaway N, et al. GLP-1R agonism enhances adjustable gastric banding in diet-induced obese rats. Diabetes. 2013;62(9):3261–7.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  21. Liu S-C, Tu Y-K, Chien M-N, Chien K-L. Effect of antidiabetic agents added to metformin on glycaemic control, hypoglycaemia and weight change in patients with type 2 diabetes: a network meta-analysis. Diabetes Obes Metab. 2012;14(9):810–20.

    Article  CAS  PubMed  Google Scholar 

  22. Tritsch AM, Bland CM, Hatzigeorgiou C, Sweeney LB, Phillips M. A retrospective review of the medical management of hypertension and diabetes mellitus following sleeve gastrectomy. Obes Surg. 2015;25(4):642–7.

    Article  PubMed  Google Scholar 

  23. Datta S, Qaadir A, Villanueva G, Baldwin D. Once-daily insulin glargine versus 6-hour sliding scale regular insulin for control of hyperglycemia after a bariatric surgical procedure: a randomized clinical trial. Endocr Pract Off J Am Coll Endocrinol Am Assoc Clin Endocrinol. 2007;13(3):225–31.

    Google Scholar 

  24. Aminian A, Brethauer SA, Daigle CR, Kirwan JP, Burguera B, Kashyap SR, et al. Outcomes of bariatric surgery in type 2 diabetic patients with diminished pancreatic secretory reserve. Acta Diabetol. 2014;51(6):1077–9.

    Article  CAS  PubMed  Google Scholar 

  25. Scheen AJ, Van Gaal LF. Combating the dual burden: therapeutic targeting of common pathways in obesity and type 2 diabetes. Lancet Diabetes Endocrinol. 2014;2(11):911–22.

    Article  CAS  PubMed  Google Scholar 

  26. Defronzo RA. Banting lecture. From the triumvirate to the ominous octet: a new paradigm for the treatment of type 2 diabetes mellitus. Diabetes. 2009;58(4):773–95.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  27. Eckel RH, Kahn SE, Ferrannini E, Goldfine AB, Nathan DM, Schwartz MW, et al. Obesity and type 2 diabetes: what can be unified and what needs to be individualized? J Clin Endocrinol Metab. 2011;96(6):1654–63.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  28. Chikunguwo SM, Wolfe LG, Dodson P, Meador JG, Baugh N, Clore JN, et al. Analysis of factors associated with durable remission of diabetes after Roux-en-Y gastric bypass. Surg Obes Relat Dis Off J Am Soc Bariatr Surg. 2010;6(3):254–9.

    Article  Google Scholar 

  29. DiGiorgi M, Rosen DJ, Choi JJ, Milone L, Schrope B, Olivero-Rivera L, et al. Re-emergence of diabetes after gastric bypass in patients with mid- to long-term follow-up. Surg Obes Relat Dis Off J Am Soc Bariatr Surg. 2010;6(3):249–53.

    Article  Google Scholar 

  30. Heber D, Greenway FL, Kaplan LM, Livingston E, Salvador J, Still C, et al. Endocrine and nutritional management of the post-bariatric surgery patient: an Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. 2010;95(11):4823–43.

    Article  CAS  PubMed  Google Scholar 

  31. Himpens J, Dobbeleir J, Peeters G. Long-term results of laparoscopic sleeve gastrectomy for obesity. Ann Surg. 2010;252(2):319–24.

    Article  PubMed  Google Scholar 

  32. Karmali S, Brar B, Shi X, Sharma AM, de Gara C, Birch DW. Weight recidivism post-bariatric surgery: a systematic review. Obes Surg. 2013;23(11):1922–33.

    Article  PubMed  Google Scholar 

  33. Odom J, Zalesin KC, Washington TL, Miller WW, Hakmeh B, Zaremba DL, et al. Behavioral predictors of weight regain after bariatric surgery. Obes Surg. 2010;20(3):349–56.

    Article  PubMed  Google Scholar 

  34. Martin DJ, Lee CMY, Rigas G, Tam CS. Predictors of weight loss 2 years after laparoscopic sleeve gastrectomy. Asian J Endosc Surg. 2015;8(3):328–32.

    Article  PubMed  Google Scholar 

  35. Robinson AH, Adler S, Stevens HB, Darcy AM, Morton JM, Safer DL. What variables are associated with successful weight loss outcomes for bariatric surgery after 1 year? Surg Obes Relat Dis Off J Am Soc Bariatr Surg. 2014;10(4):697–704.

    Article  Google Scholar 

  36. National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) final report. Circulation. 2002;106(25):3143–421.

    Google Scholar 

  37. Dyer AR, Elliott P, Shipley M. Body mass index versus height and weight in relation to blood pressure. Findings for the 10,079 persons in the INTERSALT study. Am J Epidemiol. 1990;131(4):589–96.

    CAS  PubMed  Google Scholar 

  38. Hajjar I, Kotchen TA. Trends in prevalence, awareness, treatment, and control of hypertension in the United States, 1988–2000. JAMA. 2003;290(2):199–206.

    Article  PubMed  Google Scholar 

  39. Mokdad AH, Ford ES, Bowman BA, Dietz WH, Vinicor F, Bales VS, et al. Prevalence of obesity, diabetes, and obesity-related health risk factors, 2001. JAMA. 2003;289(1):76–9.

    Article  PubMed  Google Scholar 

  40. Gelber RP, Gaziano JM, Manson JE, Buring JE, Sesso HD. A prospective study of body mass index and the risk of developing hypertension in men. Am J Hypertens. 2007;20(4):370–7.

    Article  PubMed  PubMed Central  Google Scholar 

  41. Aucott L, Poobalan A, Smith WCS, Avenell A, Jung R, Broom J. Effects of weight loss in overweight/obese individuals and long-term hypertension outcomes: a systematic review. Hypertension. 2005;45(6):1035–41.

    Article  CAS  PubMed  Google Scholar 

  42. Dornfeld LP, Maxwell MH, Waks AU, Schroth P, Tuck ML. Obesity and hypertension: long-term effects of weight reduction on blood pressure. Int J Obes. 1985;9(6):381–9.

    CAS  PubMed  Google Scholar 

  43. The hypertension prevention trial: three-year effects of dietary changes on blood pressure. Hypertension Prevention Trial Research Group. Arch Intern Med. 1990;150(1):153–62.

    Google Scholar 

  44. Schauer PR, Kashyap SR, Wolski K, Brethauer SA, Kirwan JP, Pothier CE, et al. Bariatric surgery versus intensive medical therapy in obese patients with diabetes. N Engl J Med. 2012;366(17):1567–76.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  45. Benaiges D, Sagué M, Flores-Le Roux JA, Pedro-Botet J, Ramón JM, Villatoro M, et al. Predictors of hypertension remission and recurrence after bariatric surgery. Am J Hypertens. 2016;29:653–9.

    Article  PubMed  Google Scholar 

  46. Alexander JK, Amad KH, Cole VW. Observations on some clinical features of extreme obesity, with particular reference to cardiorespiratory effects. Am J Med. 1962;32(4):512–24.

    Article  Google Scholar 

  47. Ikramuddin S, Korner J, Lee W-J, Connett JE, Inabnet WB, Billington CJ, et al. Roux-en-Y gastric bypass vs intensive medical management for the control of type 2 diabetes, hypertension, and hyperlipidemia: the Diabetes Surgery Study randomized clinical trial. JAMA. 2013;309(21):2240–9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  48. Donadelli SP, Salgado W, Marchini JS, Schmidt A, Amato CAF, Ceneviva R, et al. Change in predicted 10-year cardiovascular risk following Roux-en-Y gastric bypass surgery: who benefits? Obes Surg. 2011;21(5):569–73.

    Article  PubMed  Google Scholar 

  49. Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL, et al. The seventh report of the joint national committee on prevention, detection, evaluation, and treatment of high blood pressure: the JNC 7 report. JAMA. 2003;289(19):2560–72.

    Article  CAS  PubMed  Google Scholar 

  50. Franklin SS, Khan SA, Wong ND, Larson MG, Levy D. Is pulse pressure useful in predicting risk for coronary heart disease? The Framingham heart study. Circulation. 1999;100(4):354–60.

    Article  CAS  PubMed  Google Scholar 

  51. Benetos A, Rudnichi A, Safar M, Guize L. Pulse pressure and cardiovascular mortality in normotensive and hypertensive subjects. Hypertension. 1998;32(3):560–4.

    Article  CAS  PubMed  Google Scholar 

  52. Lee ML, Rosner BA, Weiss ST. Relationship of blood pressure to cardiovascular death: the effects of pulse pressure in the elderly. Ann Epidemiol. 1999;9(2):101–7.

    Article  CAS  PubMed  Google Scholar 

  53. Bouldin MJ, Ross LA, Sumrall CD, Loustalot FV, Low AK, Land KK. The effect of obesity surgery on obesity comorbidity. Am J Med Sci. 2006;331(4):183–93.

    Article  PubMed  Google Scholar 

  54. Sjöström CD, Peltonen M, Wedel H, Sjöström L. Differentiated long-term effects of intentional weight loss on diabetes and hypertension. Hypertension. 2000;36(1):20–5.

    Article  PubMed  Google Scholar 

  55. Segal JB, Clark JM, Shore AD, Dominici F, Magnuson T, Richards TM, et al. Prompt reduction in use of medications for comorbid conditions after bariatric surgery. Obes Surg. 2009;19(12):1646–56.

    Article  PubMed  Google Scholar 

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Author information

Authors and Affiliations

  1. Bariatric Division, Upper Gastrointestinal Surgery and Minimal Access Surgery Unit, GEM Hospital and Research Centre, Coimbatore, India

    Praveen Raj Palanivelu MS, DNB, DNB(SGE), FALS, FMAS

  2. Raihan Institute of Medical Science, Erattupetta, Moulana Hospital, Perinthalmannna, India

    Mohammed Ismail MS, FICS, FMAS

  3. Sunrise Hospital, Kochi, India

    Padmakumar DNB, MNAMS, DipALS, FAIS

  4. Department of Surgery, Fortis Malar Hospital, Chennai, India

    Deepak Subramaniam MS, MRCS

Authors
  1. Praveen Raj Palanivelu MS, DNB, DNB(SGE), FALS, FMAS
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  2. Mohammed Ismail MS, FICS, FMAS
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  3. Padmakumar DNB, MNAMS, DipALS, FAIS
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  4. Deepak Subramaniam MS, MRCS
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Correspondence to Praveen Raj Palanivelu MS, DNB, DNB(SGE), FALS, FMAS .

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Editors and Affiliations

  1. Bariatric Division, Upper Gastrointestinal Surgery and Minimal Access Surgery Unit, GEM Hospital and Research Centre, Coimbatore, Tamil Nadu, India

    Saravana Kumar

  2. Bariatric Division, Upper Gastrointestinal Surgery and Minimal Access Surgery Unit, GEM Hospital and Research Centre, Coimbatore, Tamil Nadu, India

    Rachel Maria Gomes

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Palanivelu, P.R., Ismail, M., Padmakumar, Subramaniam, D. (2017). Perioperative Management of Medical Comorbidities After Bariatric Surgery. In: Kumar, S., Gomes, R. (eds) Bariatric Surgical Practice Guide. Springer, Singapore. https://doi.org/10.1007/978-981-10-2705-5_20

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  • DOI: https://doi.org/10.1007/978-981-10-2705-5_20

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