- •Up to 50% of patients with T2D remission after MBS present disease recurrence during 3-15 years follow-up.
- •The available evidence supports the use of GLP-1 analogues as the most suitable therapy option for T2D recurrence after MBS.
- •Patients with recurrent T2D might require reinstitution of pharmacotherapy to reach cardiovascular risk factors targets.
- •Time from intervention may influence the bioavailability of lipid lowering and anti-hypertensive drugs after MBS.
- •A close monitoring of post-bariatric patients is advised for therapy adjustments and control of cardiovascular risk factors.
2. Remission and recurrence of type 2 diabetes after MBS
- Carlsson L.M.S.
- Sjoholm K.
- Karlsson C.
- Jacobson P.
- Andersson-Assarsson J.C.
- Svensson P.A.
- et al.
- Syn N.L.
- Cummings D.E.
- Wang L.Z.
- Lin D.J.
- Zhao J.J.
- Loh M.
- et al.
3. Clinical management of persistent or recurrent type 2 diabetes
|Glucose lowering Agent||HbA1c||Body weight||CV protection||Renal protection||Concerns in patients following MBS||Evidence in patients following MBS|
|GLP-1 analogues||More pronounced gastrointestinal side effects||Yes|
|DPP-4 inhibitors||Modest improvement in glycemic control in case of moderate/severe hyperglycemia||Poor|
|SGLT-2 inhibitors||Increased risk of eDKA in perioperative phase|
Increased risk of dehydration
Increased risk of Vit D deficiency
|Metformin||Increased toxicity risk (increased bioavailability)|
More pronounced gastrointestinal side effects
Increased risk of Vit B12 deficiency
|Sulfonylureas||Increased risk of hypoglycemia|
Increased risk of weight gain
|Thiazolidinediones||Increased risk of weight gain, fluid retention and bone fractures||No|
|Insulin||Increased risk of weight gain|
Increased risk of hypoglycemia
3.1 GLP1- analogues
- Jendle J.
- Nauck M.A.
- Matthews D.R.
- Frid A.
- Hermansen K.
- During M.
- et al.
- Miras A.D.
- Perez-Pevida B.
- Aldhwayan M.
- Kamocka A.
- McGlone E.R.
- Al-Najim W.
- et al.
- Kristensen S.L.
- Rorth R.
- Jhund P.S.
- Docherty K.F.
- Sattar N.
- Preiss D.
- et al.
- O'Neil P.M.
- Birkenfeld A.L.
- McGowan B.
- Mosenzon O.
- Pedersen S.D.
- Wharton S.
- et al.
3.2 Other therapeutic options
4. Management of CVD risk factors in T2D patients undergoing MBS: is pharmacokinetics of oral drugs an additional challenge?
|Oral drug||Evidence from available studies in patients following MBS||General suggestions for clinical management|
|Strength of suggestions|
|Atorvastatin||Increased bioavailability in the first weeks after MBS; further possible changes in the long-term||Regular monitoring of lipid profile for dose adjustment||Weak|
|Fenofibrate||Unaltered disposition after RYGB||No dose adjustment for pharmacokinetic issues is required after RYGB||Weak|
|Acetylsalicylic acid||Increased absorption and disposition after RYGBP||No adjustment of the standard daily dose is required after RYGB||Weak|
|Anticoagulants||Modified pharmacokinetic of warfarin; pharmacokinetic of rivaroxaban and apixaban does not change||Dosage of warfarin should be decreased in the first weeks after MBS and increased afterward; no dose adjustment is required for rivaroxaban and apixaban||Weak|
|Beta blockers||Modified pharmacokinetic of propranolol; pharmacokinetic of atenolol does not change||Atenolol should be preferred||Weak|
- Bays H.
- Kothari S.N.
- Azagury D.E.
- Morton J.M.
- Nguyen N.T.
- Jones P.H.
- et al.
- Bays H.
- Kothari S.N.
- Azagury D.E.
- Morton J.M.
- Nguyen N.T.
- Jones P.H.
- et al.
Declaration of competing interest
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