Diabetes management in people undergoing metabolic‐bariatric surgery: A guideline from the Joint British Diabetes Societies for Inpatient Care ( JBDS ‐ IP ) Group
Recommendations
As issued by the authors
Multidisciplinary care and individualised treatment plans to optimise outcomes
Pre-operative glycaemic optimisation, targeting HbA1c <69 mmol/mol (<8.5%) where safe to do so
Prevention of hypoglycaemia throughout all phases of care; framework for medication adjustments during the liver reduction diet (LRD), peri-operative and post-operative phases
T2D: metformin, DPP4 inhibitors and GLP-1 based therapies may be continued during LRD; sulfonylureas, meglitinides and SGLT2 inhibitors should be discontinued to reduce hypoglycaemia risk
T2D on insulin: reduce doses by 35%-50% during LRD and adjust post-operatively based on individual glycaemic control
T1D: to prevent diabetic ketoacidosis (DKA), insulin must never be stopped; careful planning with diabetes teams is essential
Post-operatively: regular glucose monitoring, hypoglycaemia surveillance, medication adjustments and follow-up with diabetes specialists
Original publication
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