Researchers at the Cleveland Clinic have found that while bariatric surgery is considered a safe and effective treatment for obesity and its comorbidities, diabetic ketoacidosis (DKA) can occur in diabetic patients following weight-loss procedures. The findings were recently published in Diabetes Care.
The investigators, led by Ali Aminian, MD, point out that the characteristics of DKA following bariatric surgery have not been explored, so they analyzed 12 patients who from January 2005 to December 2015 developed DKA within 90 days of surgery. Eight of these patients had type 1 diabetes (T1D), while four had type 2 diabetes (T2D), and three of them had a past history of DKA. Six patients had undergone laparoscopic Roux-en-Y gastric bypass, four underwent laparoscopic sleeve gastrectomy, and two had laparoscopic adjustable gastric banding. One patient even developed two episodes of postoperative DKA.
The authors also point out that eight of these patients had inadequate insulin therapy or were non-compliant, and three of these patients developed DKA before they were even discharged from the hospital following their weight-loss procedures, which they write “could be explained by the combination of undertreatment with insulin and surgical stress.” The median time between surgery and DKA was 12 days.
“Infection was a precipitating factor for the development of DKA in four (33%) patients,” the authors write. “Poor oral intake (for several days) could be a contributing factor in three (25%) patients.”
Aminian and his team note that this is the largest case series of this kind to date. Based on what they observed in this study, as well as the literature, they conclude that it’s not uncommon for patients with poorly controlled T1D to develop DKA following bariatric surgery, while it is uncommon for patients with T2D to develop DKA after surgery, and if they do, it’s usually mild. What’s more, stress from the surgery, inadequate treatment during the surgery, postoperative infection, and a number of other factors can be precipitating causes of DKA.
Patients must have optimal glycemic control before bariatric surgery, even the morning of the surgery, and patients must be kept on insulin during the surgery, the authors write. Candidates for bariatric surgery can benefit from a healthier diet leading up to the surgery, as well as after, and insulin dosages must be adjusted accordingly.
“Early detection and aggressive diabetes care are needed to treat this serious adverse event,” the authors conclude.
Loading ...