Hi Tammy,

Because large population of patients have weight regain after bariatric surgery i.e. "failed VSG", despite the dramatic lifestyle changes following surgery ( even those who become candidates for different gastric Bypass surgeries: Roux-en-Y, SADI-s, mini Gastric Bypass ... ), the incretin pharmacotherapy is instated instead.

I am sure you will find more papers on the subject, but here is an example:

Article Efficacy of High-Dose Liraglutide as an Adjunct for Weight L...

Hope that helps

best wishes

Thank you for this information. Is there an indication for use of GLP-1 meds for optimizing glycemic control for those patients who remain on meds for diabetes post bariatric surgery?

Unfortunately,, no specific recommendations for peri-operative antidiabetic management exist. (ref: Article Glycemic Management in the Bariatric Surgery Population: A R...

Article Glycaemic control in the perioperative period

Article Practical management of diabetes patients before, during and...

The ASMBS Position recommendations are made in the patient with postprandial hyperinsulinemic hypoglycemia after bariatric surgery (ref

Article ASMBS Position Statement on Postprandial Hyperinsulinemic Hy...

There is no single agreed-upon criterion of post metabolic surgery glycemic control. The consensus is to tailor a multidisciplinary care plan based on each case. To date to the best of my knowledge ,, the DSS-II guidelines formally endorsed by medical/ scientific societies details current practices, benefits and limitations of metabolic surgery for T2D (ref. Article Metabolic Surgery in the Treatment Algorithm for Type 2 Diab...

and Guidelines for adjustments of antidiabetic treatment before and after bariatric surgery are Scarce (ref Article Treatment of Diabetes Prior to and after Bariatric Surgery

hope this helps you find what you are looking for.

Best Wishes

Ghanim.

Excellent question.

Any answer in the past months? (I come to this question a bit after the fact).

I would wonder what the thinking might be as to why medications for the bariatric population (postop or pre-op) would be any different from a non-bariatric population.

Ghanim Al-Khaledi , Excellent detailed answer!

Most RNY/sleeve patients typically regain 2/3 of their weight as a result of the body adapting to the surgery (K/L cell migration) in the face of fundamental continuation of the Western (high omega-6, low fiber, low polyphenol, high sugar) diet, lack of type II muscle fiber training (or high intensity exercise), and lack of periods of fasting long enough for insulin to drop low enough to enable autophagy and fat burning.

Diabetes medications can delay the return of insulin resistance in the face of the above, regardless of the number of surgeries one has had / yet to have.

Tangential: Conversations around centers of excellence guidelines in the US included emphasis on increasing patient followup particularly at the 2+ year post op mark in order to confirm return to likely insulin resistance (implied by A1C) . To accommodate this growing population, a majority of centers either had or had plans to recruit a surgeon skilled with revision surgery. (Typical Lap-->DS conversion).

measure oxyntomodulin after Bariatric surgery. it gave wonderful results.

anshlabs has oxyntomodulin and GLp1 ELISA

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