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

• Kim K
• Choi SH
• Jang HC
• Park YS
• Oh TJ

• KMID: 2533640
• DOI: http://doi.org/10.4093/dmj.2021.0164

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.

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