Using Continuous Glucose Monitoring for Patients Who Have Undergone Metabolic Surgery

  • H. Y. Yu
  • Y. BaoEmail author


Diabetes mellitus (DM) is a chronic disease, and its treatment measures include diet therapy, moderate exercise, medication, glucose monitoring, and diabetes education. Over the past decade, metabolic surgery has become an important means for treating obese patients with type 2 diabetes mellitus (T2DM) that makes long-term remission or even reversal possible. Although metabolic surgery can significantly improve the overall blood glucose levels and effectively reduce the glycated hemoglobin A1c (HbA1c), the improvement of glucose variability varies after different surgical procedures. Continuous glucose monitoring (CGM) is an effective means to evaluate glucose variability. We previously compared the preoperative and 1-year postoperative CGM data of 43 obese patients with type 2 diabetes who underwent Roux-en-Y gastric bypass (RYGB), and we found patients’ HbA1c levels were improved after the operation but the mean amplitude of glycemic excursion (MAGE) levels was not. Thus, postoperative glucose variability after RYGB and its interventions remain to be major challenges.


Continuous glucose monitoring Diabetes mellitus Obesity Metabolic surgery 


  1. 1.
    Yang W, Lu J, Weng J, Jia W, Ji L, Xiao J, Shan Z, Liu J, Tian H, Ji Q, Zhu D, Ge J, Lin L, Chen L, Guo X, Zhao Z, Li Q, Zhou Z, Shan G, He J, China National Diabetes and Metabolic Disorders Study Group. Prevalence of diabetes among men and women in China. N Engl J Med. 2010;362:1090–101. Scholar
  2. 2.
    Hou X, Lu J, Weng J, Ji L, Shan Z, Liu J, Tian H, Ji Q, Zhu D, Ge J, Lin L, Chen L, Guo X, Zhao Z, Li Q, Zhou Z, Shan G, Yang Z, Yang W, Jia W, China National Diabetes and Metabolic Disorders Study Group. Impact of waist circumference and body mass index on risk of cardiometabolic disorder and cardiovascular disease in Chinese adults: a national diabetes and metabolic disorders survey. PloS One. 2013;8:e57319. Scholar
  3. 3.
    Pories WJ, Swanson MS, MacDonald KG, Long SB, Morris PG, Brown BM, Barakat HA, deRamon RA, Israel G, Dolezal JM. 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.CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Schauer PR, Kashyap SR, Wolski K, Brethauer SA, Kirwan JP, Pothier CE, Thomas S, Abood B, Nissen SE, Bhatt DL. Bariatric surgery versus intensive medical therapy in obese patients with diabetes. N Engl J Med. 2012;366:1567–76. Scholar
  5. 5.
    Mingrone G, Panunzi S, De Gaetano A, Guidone C, Iaconelli A, Leccesi L, Nanni G, Pomp A, Castagneto M, Ghirlanda G, Rubino F. Bariatric surgery versus conventional medical therapy for type 2 diabetes. N Engl J Med. 2012;366:1577–85. Scholar
  6. 6.
    Rubino F. Is type 2 diabetes an operable intestinal disease? A provocative yet reasonable hypothesis. Diabetes Care. 2008;31(Suppl 2):290–6. Scholar
  7. 7.
    Yu H, Zhang L, Bao Y, Zhang P, Tu Y, Di J, Han X, Han J, Jia W. Metabolic syndrome after Roux-en-Y gastric bypass surgery in Chinese obese patients with type 2 diabetes. Obes Surg. 2016;26:2190–7. Scholar
  8. 8.
    Xu H, Zhang P, Han X, Yu H, Di J, Zou J, Wang Y, Qian Y, Tu Y, Bao Y, Yi H, Guan J, Yin S, Jia W. Sex effect on obesity indices and metabolic outcomes in patients with obese obstructive sleep apnea and type 2 diabetes after laparoscopic Roux-en-Y gastric bypass surgery: a preliminary study. Obes Surg. 2016;26:2629–39. Scholar
  9. 9.
    Zhang H, Di J, Yu H, Han X, Li K, Zhang P. The short-term remission of diabetic nephropathy after Roux-en-Y gastric bypass in Chinese patients of T2DM with obesity. Obes Surg. 2015;25:1263–70. Scholar
  10. 10.
    Yu H, Chen J, Lu J, Bao Y, Tu Y, Zhang L, Zhang P, Jia W. Decreased visceral fat area correlates with improved arterial stiffness after Roux-en-Y gastric bypass in Chinese obese patients with type 2 diabetes mellitus: a 12-month follow-up. Surg Obes Relat Dis. 2016;12:550–5. Scholar
  11. 11.
    Hoerger TJ, Zhang P, Segel JE, Kahn HS, Barker LE, Couper S. Cost-effectiveness of bariatric surgery for severely obese adults with diabetes. Diabetes Care. 2010;33:1933. Scholar
  12. 12.
    Zimmet P, Alberti KG, Rubino F, Dixon JB. IDF’s view of bariatric surgery in type 2 diabetes. Lancet. 2011;378:108–10. Scholar
  13. 13.
    Rubino F, Nathan DM, Eckel RH, Schauer PR, Alberti KG, Zimmet PZ, Del Prato S, Ji L, Sadikot SM, Herman WH, Amiel SA, Kaplan LM, Taroncher-Oldenburg G, Cummings DE, Delegates of the 2nd Diabetes Surgery Summit. Metabolic surgery in the treatment algorithm for type 2 diabetes: A Joint Statement by international diabetes organizations. Diabetes Care. 2016;39:861–77. Scholar
  14. 14.
    Bantle JP, Ikramuddin S, Kellogg TA, Buchwald H. Hyperinsulinemic hypoglycemia developing late after gastric bypass. Obes Surg. 2007;17:592–4.CrossRefPubMedGoogle Scholar
  15. 15.
    Hanaire H, Bertrand M, Guerci B, Anduze Y, Guillaume E, Ritz P. High glycemic variability assessed by continuous glucose monitoring after surgical treatment of obesity by gastric bypass. Diabetes Technol Ther. 2011;13:625–30. Scholar
  16. 16.
    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. Scholar
  17. 17.
    Abrahamsson N, Eden Engstrom B, Sundbom M, Karlsson FA. Hypoglycemia in everyday life after gastric bypass and duodenal switch. Eur J Endocrinol. 2015;173:91–100.
  18. 18.
    Marfella R, Barbieri M, Ruggiero R, Rizzo MR, Grella R, Mozzillo AL, Docimo L, Paolisso G. Bariatric surgery reduces oxidative stress by blunting 24-h acute glucose fluctuations in type 2 diabetic obese patients. Diabetes Care. 2010;33:287–9. Scholar
  19. 19.
    Chinese Diabetes Society. Standards of care for type 2 diabetes in China (2013). Chin J Endocrinol Metab. 2014;30:893–942. Scholar
  20. 20.
    Zhou J, Li H, Ran X, Yang W, Li Q, Peng Y, Li Y, Gao X, Luan X, Wang W, Jia W. Reference values for continuous glucose monitoring in Chinese subjects. Diabetes Care. 2009;32:1188–93. Scholar
  21. 21.
    Yu H, Zhou J, Bao Y, Pin Z, Lu W, Jia W. “Dual-remission” after Roux-en-Y gastric bypass surgery: glycemic variability cannot always be improved in Chinese obese patients with type 2 diabetes. Surg Obes Relat Dis. 2016;12:1312–9.
  22. 22.
    Stearns AT, Balakrishnan A, Tavakkolizadeh A. Impact of Roux-en-Y gastric bypass surgery on rat intestinal glucose transport. Am J Physiol Gastrointest Liver Physiol. 2009;297:G950–7. Scholar
  23. 23.
    Leturque A, Brot-Laroche E, Le Gall M. GLUT2 mutations, translocation, and receptor function in diet sugar managing. Am J Physiol Endocrinol Metab. 2009;296:E985–92. Scholar
  24. 24.
    Roslin MS, Oren JH, Polan BN, Damani T, Brauner R, Shah PC. Abnormal glucose tolerance testing after gastric bypass. Surg Obes Relat Dis. 2013;9:26–31. Scholar
  25. 25.
    Tramunt B, Vaurs C, Lijeron J, Guillaume E, Ritz P, Diméglio C, Hanaire H. Impact of carbohydrate content and glycemic load on postprandial glucose after Roux-en-Y gastric bypass. Obes Surg. 2016;26:1487–92. Scholar
  26. 26.
    Ritz P, Vaurs C, Bertrand M, Anduze Y, Guillaume E, Hanaire H. Usefulness of acarbose and dietary modifications to limit glycemic variability following Roux-en-Y gastric bypass as assessed by continuous glucose monitoring. Diabetes Technol Ther. 2012;14:736–40. Scholar

Copyright information

© Springer Nature Singapore Pte Ltd. and Shanghai Scientific and Technical Publishers 2018

Authors and Affiliations

  1. 1.Department of Endocrinology and Metabolism, Shanghai Clinical Center for Diabetes, Shanghai Diabetes InstituteShanghai Jiao Tong University, Affiliated Sixth People’s HospitalShanghaiChina

Personalised recommendations