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Diabetes management in people undergoing metabolic-bariatric surgery: A guideline from the Joint British Diabetes Societies for Inpatient Care (JBDS-IP) Group
,
Ketan Dhatariya ,
Andrew J. Beamish,
Dimitri J. Pournaras ,
Alexander D. Miras ,
Nader Raafat,
Georgia Noble‐Bell,
Rachel Cadwallader Buckland ,
Omar G. Mustafa
Diabetic Medicine, Volume: 43, Issue: 5
Swansea University Author:
Jeffrey Stephens
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© 2026 The Author(s). This is an open access article under the terms of the Creative Commons Attribution-NonCommercial License.
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DOI (Published version): 10.1111/dme.70281
Abstract
The global prevalence of obesity and diabetes continues to rise, with metabolic-bariatric surgery recognised as an effective intervention for obesity and type 2 diabetes, offering potential for type 2 diabetes remission and improved glycaemic control. This guideline, developed by the Joint British D...
| Published in: | Diabetic Medicine |
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| ISSN: | 0742-3071 1464-5491 |
| Published: |
Wiley
2026
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| Online Access: |
Check full text
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| URI: | https://cronfa.swan.ac.uk/Record/cronfa71659 |
| Abstract: |
The global prevalence of obesity and diabetes continues to rise, with metabolic-bariatric surgery recognised as an effective intervention for obesity and type 2 diabetes, offering potential for type 2 diabetes remission and improved glycaemic control. This guideline, developed by the Joint British Diabetes Societies for Inpatient Care (JBDS-IP), provides recommendations for the management of diabetes in individuals undergoing metabolic-bariatric surgery. It emphasises the importance of multidisciplinary care and individualised treatment plans to optimise outcomes. Key recommendations include pre-operative glycaemic optimisation, targeting HbA1c <69 mmol/mol (<8.5%) where safe to do so, prevention of hypoglycaemia throughout all phases of care and providing a framework for medication adjustments during the liver reduction diet (LRD), peri-operative and post-operative phases. For type 2 diabetes, oral and non-insulin therapies such as metformin, DPP4 inhibitors and GLP-1 based therapies may be continued during LRD, while sulfonylureas, meglitinides and SGLT2 inhibitors should be discontinued to reduce the risk of hypoglycaemia. For those with type 2 diabetes on insulin, doses should be reduced by 35%–50% during LRD and adjusted post-operatively based on individual glycaemic control. To prevent diabetic ketoacidosis (DKA) in those with type 1 diabetes, insulin must never be stopped and careful planning with diabetes teams is essential. Post-operatively, regular glucose monitoring, hypoglycaemia surveillance, medication adjustments, and follow-up with diabetes specialists are recommended. This document serves as a guide for clinicians and service commissioners, aiming to improve inpatient diabetes care and outcomes for individuals undergoing metabolic-bariatric surgery. |
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| Keywords: |
bariatric surgery; hospital; inpatient diabetes; metabolic surgery |
| College: |
Faculty of Medicine, Health and Life Sciences |
| Issue: |
5 |