Glucose Profiles Assessed by Intermittently Scanned Continuous Glucose Monitoring System during the Perioperative Period of Metabolic Surgery - PubMed (original) (raw)

Glucose Profiles Assessed by Intermittently Scanned Continuous Glucose Monitoring System during the Perioperative Period of Metabolic Surgery

Kyuho Kim et al. Diabetes Metab J. 2022 Sep.

Abstract

Background: Continuous glucose monitoring (CGM) has been widely used in the management of diabetes. However, the usefulness and detailed data during perioperative status were not well studied. In this study, we described the immediate changes of glucose profiles after metabolic surgery using intermittently scanned CGM (isCGM) in individuals with type 2 diabetes mellitus (T2DM).

Methods: This was a prospective, single-center, single-arm study including 20 participants with T2DM. The isCGM (FreeStyle Libre CGM) implantation was performed within 2 weeks before surgery. We compared CGM metrics of 3 days before surgery and 3 days after surgery, and performed the correlation analyses with clinical variables.

Results: The mean glucose significantly decreased after surgery (147.0±40.4 to 95.5±17.1 mg/dL, P<0.001). Time in range (TIR; 70 to 180 mg/dL) did not significantly change after surgery in total. However, it was significantly increased in a subgroup of individuals with glycosylated hemoglobin (HbA1c) ≥8.0%. Time above range (>250 or 180 mg/dL) was significantly decreased in total. In contrast, time below range (<70 or 54 mg/dL) was significantly increased in total and especially in a subgroup of individuals with HbA1c <8.0% after surgery. The coefficient of variation significantly decreased after surgery. Higher baseline HbA1c was correlated with greater improvement in TIR (rho=0.607, P=0.005).

Conclusion: The isCGM identified improvement of mean glucose and glycemic variability, and increase of hypoglycemia after metabolic surgery, but TIR was not significantly changed after surgery. We detected an increase of TIR only in individuals with HbA1c ≥8.0%.

Keywords: Bariatric surgery; Blood glucose; Blood glucose self-monitoring; Diabetes mellitus, type 2.

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Conflict of interest statement

CONFLICTS OF INTEREST

Sung Hee Choi has been editorial board member of the Diabetes & Metabolism Journal since 2021. She was not involved in the review process of this article. Otherwise, there was no conflict of interest.

Figures

Fig. 1

Fig. 1

(A) Study design. (B) Daily glucose profiles before and after metabolic surgery. Op, operation; CGM, continuous glucose monitoring; NPO, nil per os; SOW, sips of water; SFD, soft fluid diet; GIK, glucose–insulin–potassium; D/C, discontinue; SGLT2i, sodium-glucose cotransporter-2 inhibitor; OAD, oral antidiabetic drug; BST, blood sugar test.

Fig. 2

Fig. 2

Percentage of time above range (>180 or >250 mg/dL), time in range (70 to 180 mg/dL), and time below range (<70 or < 54 mg/dL). HbA1c, glycosylated hemoglobin. a_P_<0.05 vs. before surgery, b_P_<0.01 vs. before surgery, c_P_<0.001 vs. before surgery.

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References

    1. Nguyen NT, Varela JE. Bariatric surgery for obesity and metabolic disorders: state of the art. Nat Rev Gastroenterol Hepatol. 2017;14:160–9. - PubMed
    1. Wickremesekera K, Miller G, Naotunne TD, Knowles G, Stubbs RS. Loss of insulin resistance after Roux-en-Y gastric bypass surgery: a time course study. Obes Surg. 2005;15:474–81. - PubMed
    1. Pories WJ, Swanson MS, MacDonald KG, Long SB, Morris PG, Brown BM, et al. Who would have thought it?: an operation proves to be the most effective therapy for adult-onset diabetes mellitus. Ann Surg. 1995;222:339–52. - PMC - PubMed
    1. Busetto L, Dicker D, Azran C, Batterham RL, Farpour-Lambert N, Fried M, et al. Practical recommendations of the Obesity Management Task Force of the European Association for the Study of Obesity for the post-bariatric surgery medical management. Obes Facts. 2017;10:597–632. - PMC - PubMed
    1. Vigersky R, Shrivastav M. Role of continuous glucose monitoring for type 2 in diabetes management and research. J Diabetes Complications. 2017;31:280–7. - PubMed

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