Diabetes Metab J.  2022 Sep;46(5):713-721. 10.4093/dmj.2021.0164.

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

Affiliations
  • 1Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
  • 2Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
  • 3Department of Surgery, Seoul National University Bundang Hospital, Seongnam, Korea

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%.

Keyword

Bariatric surgery; Blood glucose; Blood glucose self-monitoring; Diabetes mellitus; type 2

Figure

  • 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 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. aP<0.05 vs. before surgery, bP<0.01 vs. before surgery, cP<0.001 vs. before surgery.


Cited by  1 articles

Asymptomatic Hypoglycemia after Metabolic Surgery: New Insights from Perioperative Continuous Glucose Monitoring
Sang-Man Jin
Diabetes Metab J. 2022;46(5):675-676.    doi: 10.4093/dmj.2022.0307.


Reference

1. Nguyen NT, Varela JE. Bariatric surgery for obesity and metabolic disorders: state of the art. Nat Rev Gastroenterol Hepatol. 2017; 14:160–9.
Article
2. 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.
Article
3. 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.
Article
4. 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.
Article
5. Vigersky R, Shrivastav M. Role of continuous glucose monitoring for type 2 in diabetes management and research. J Diabetes Complications. 2017; 31:280–7.
Article
6. Cappon G, Vettoretti M, Sparacino G, Facchinetti A. Continuous glucose monitoring sensors for diabetes management: a review of technologies and applications. Diabetes Metab J. 2019; 43:383–97.
Article
7. Edelman SV, Argento NB, Pettus J, Hirsch IB. Clinical implications of real-time and intermittently scanned continuous glucose monitoring. Diabetes Care. 2018; 41:2265–74.
Article
8. Yip S, Signal M, Smith G, Beban G, Booth M, Babor R, et al. Lower glycemic fluctuations early after bariatric surgery partially explained by caloric restriction. Obes Surg. 2014; 24:62–70.
Article
9. Wysocki M, Szopa M, Stefura T, Dudek A, Torbicz G, Gajewska N, et al. Continuous glucose monitoring in bariatric patients undergoing laparoscopic sleeve gastrectomy and laparoscopic Roux-En-Y gastric bypass. Obes Surg. 2019; 29:1317–26.
Article
10. Diabetes Research in Children Network (DirecNet) Study Group. The accuracy of the Guardian RT continuous glucose monitor in children with type 1 diabetes. Diabetes Technol Ther. 2008; 10:266–72.
11. Battelino T, Danne T, Bergenstal RM, Amiel SA, Beck R, Biester T, et al. Clinical targets for continuous glucose monitoring data interpretation: recommendations from the International Consensus on Time in Range. Diabetes Care. 2019; 42:1593–603.
12. Danne T, Nimri R, Battelino T, Bergenstal RM, Close KL, DeVries JH, et al. International consensus on use of continuous glucose monitoring. Diabetes Care. 2017; 40:1631–40.
Article
13. Oh TJ, Kook JH, Jung SY, Kim DW, Choi SH, Kim HB, et al. A standardized glucose-insulin-potassium infusion protocol in surgical patients: use of real clinical data from a clinical data warehouse. Diabetes Res Clin Pract. 2021; 174:108756.
Article
14. Sondergaard E, Espinosa De Ycaza AE, Morgan-Bathke M, Jensen MD. How to measure adipose tissue insulin sensitivity. J Clin Endocrinol Metab. 2017; 102:1193–9.
Article
15. Yoo JH, Kim JH. Time in range from continuous glucose monitoring: a novel metric for glycemic control. Diabetes Metab J. 2020; 44:828–39.
Article
16. Schierenbeck F, Franco-Cereceda A, Liska J. Accuracy of 2 different continuous glucose monitoring systems in patients undergoing cardiac surgery. J Diabetes Sci Technol. 2017; 11:108–16.
Article
17. Perez-Guzman MC, Duggan E, Gibanica S, Cardona S, Corujo-Rodriguez A, Faloye A, et al. Continuous glucose monitoring in the operating room and cardiac intensive care unit. Diabetes Care. 2021; 44:e50–2.
Article
18. Bailey T, Bode BW, Christiansen MP, Klaff LJ, Alva S. The performance and usability of a factory-calibrated flash glucose monitoring system. Diabetes Technol Ther. 2015; 17:787–94.
Article
19. Kefurt R, Langer FB, Schindler K, Shakeri-Leidenmuhler S, Ludvik B, Prager G. Hypoglycemia after Roux-En-Y gastric bypass: detection rates of continuous glucose monitoring (CGM) versus mixed meal test. Surg Obes Relat Dis. 2015; 11:564–9.
Article
20. Hanaire H, Dubet A, Chauveau ME, Anduze Y, Fernandes M, Melki V, et al. Usefulness of continuous glucose monitoring for the diagnosis of hypoglycemia after a gastric bypass in a patient previously treated for type 2 diabetes. Obes Surg. 2010; 20:126–9.
Article
21. Pleus S, Heinemann L, Freckmann G. Blood glucose monitoring data should be reported in detail when studies about efficacy of continuous glucose monitoring systems are published. J Diabetes Sci Technol. 2018; 12:1061–3.
Article
22. Galindo RJ, Migdal AL, Davis GM, Urrutia MA, Albury B, Zambrano C, et al. Comparison of the FreeStyle Libre Pro Flash continuous glucose monitoring (CGM) system and point-of-care capillary glucose testing in hospitalized patients with type 2 diabetes treated with basal-bolus insulin regimen. Diabetes Care. 2020; 43:2730–5.
23. Hofso D, Fatima F, Borgeraas H, Birkeland KI, Gulseth HL, Hertel JK, et al. Gastric bypass versus sleeve gastrectomy in patients with type 2 diabetes (Oseberg): a single-centre, triple-blind, randomised controlled trial. Lancet Diabetes Endocrinol. 2019; 7:912–24.
Article
24. Wang L, Shi C, Yan H, Xia M, Zhu X, Sun X, et al. Acute effects of sleeve gastrectomy on glucose variability, glucose metabolism, and ghrelin response. Obes Surg. 2021; 31:4005–14.
Article
25. Lee WJ, Hur KY, Lakadawala M, Kasama K, Wong SK, Chen SC, et al. Predicting success of metabolic surgery: age, body mass index, C-peptide, and duration score. Surg Obes Relat Dis. 2013; 9:379–84.
Article
26. Still CD, Wood GC, Benotti P, Petrick AT, Gabrielsen J, Strodel WE, et al. Preoperative prediction of type 2 diabetes remission after Roux-en-Y gastric bypass surgery: a retrospective cohort study. Lancet Diabetes Endocrinol. 2014; 2:38–45.
Article
27. Bojsen-Moller KN, Dirksen C, Jorgensen NB, Jacobsen SH, Serup AK, Albers PH, et al. Early enhancements of hepatic and later of peripheral insulin sensitivity combined with increased postprandial insulin secretion contribute to improved glycemic control after Roux-en-Y gastric bypass. Diabetes. 2014; 63:1725–37.
Article
28. Camastra S, Gastaldelli A, Mari A, Bonuccelli S, Scartabelli G, Frascerra S, et al. Early and longer term effects of gastric bypass surgery on tissue-specific insulin sensitivity and beta cell function in morbidly obese patients with and without type 2 diabetes. Diabetologia. 2011; 54:2093–102.
Article
29. Dagogo-Jack S, Alberti KG. Management of diabetes mellitus in surgical patients. Diabetes Spectr. 2002; 15:44–8.
Article
Full Text Links
  • DMJ
Actions
Cited
CITED
export Copy
Close
Share
  • Twitter
  • Facebook
Similar articles
Copyright © 2024 by Korean Association of Medical Journal Editors. All rights reserved.     E-mail: koreamed@kamje.or.kr