POSTOPERATIVE INSULIN REQUIREMENTS IN BARIATRIC SURGERY

Area of Science:

• Endocrinology
• Metabolic Surgery
• Diabetes Management

Background:

• Type 2 diabetes mellitus (DM) management often involves insulin therapy.
• Roux-en-Y gastric bypass (RYGB) is a bariatric procedure known to impact metabolic health.
• Limited data exist on immediate postoperative insulin requirements after RYGB.

Purpose of the Study:

• To determine peri-operative glycemic control in patients with type 2 DM on insulin undergoing RYGB.
• To compare pre- and postoperative insulin regimens and dosages in these patients.

Main Methods:

• Retrospective chart review of patients with type 2 DM on insulin who underwent RYGB.
• Comparison of blood glucose (BG) levels and insulin doses before surgery, on the day of surgery (DOS), and postoperative days (POD) 1 and 2.
• Subgroup analysis to correlate insulin dose with glucose control.

Main Results:

• Mean BG significantly decreased from DOS to POD2 (185 to 160 mg/dL).
• Median daily insulin dose decreased significantly from 75 units pre-surgery to 6 units by POD2 (P<.0001).
• Median insulin dose per body weight also significantly decreased (0.58 to 0.04 units/kg, P<.0001).

Conclusions:

• An 87.5% reduction in total daily insulin dose was observed by POD2.
• These findings aid in developing algorithms for insulin titration postbariatric surgery.
• RYGB leads to rapid and substantial reductions in insulin requirements for type 2 diabetes patients.