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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

Jeffrey Stephens Orcid Logo, Ketan Dhatariya Orcid Logo, Andrew J. Beamish, Dimitri J. Pournaras Orcid Logo, Alexander D. Miras Orcid Logo, Nader Raafat, Georgia Noble‐Bell, Rachel Cadwallader Buckland Orcid Logo, Omar G. Mustafa Orcid Logo

Diabetic Medicine, Volume: 43, Issue: 5

Swansea University Author: Jeffrey Stephens Orcid Logo

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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...

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Published in: Diabetic Medicine
ISSN: 0742-3071 1464-5491
Published: Wiley 2026
Online Access: Check full text

URI: https://cronfa.swan.ac.uk/Record/cronfa71659
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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 &lt;69&#x2009;mmol/mol (&lt;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. 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spelling 2026-04-23T14:03:18.4738313 v2 71659 2026-03-23 Diabetes management in people undergoing metabolic-bariatric surgery: A guideline from the Joint British Diabetes Societies for Inpatient Care (JBDS-IP) Group 5219d126f97f8f884bdb622099bd41de 0000-0003-2228-086X Jeffrey Stephens Jeffrey Stephens true false 2026-03-23 MEDS 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. Journal Article Diabetic Medicine 43 5 Wiley 0742-3071 1464-5491 bariatric surgery; hospital; inpatient diabetes; metabolic surgery 1 5 2026 2026-05-01 10.1111/dme.70281 COLLEGE NANME Medical School COLLEGE CODE MEDS Swansea University Not Required 2026-04-23T14:03:18.4738313 2026-03-23T10:43:43.8592445 Faculty of Medicine, Health and Life Sciences Swansea University Medical School - Biomedical Science Jeffrey Stephens 0000-0003-2228-086X 1 Ketan Dhatariya 0000-0003-3619-9579 2 Andrew J. Beamish 3 Dimitri J. Pournaras 0000-0001-8798-920x 4 Alexander D. Miras 0000-0003-3830-3173 5 Nader Raafat 6 Georgia Noble‐Bell 7 Rachel Cadwallader Buckland 0000-0001-6322-8043 8 Omar G. Mustafa 0000-0003-3123-809x 9 71659__36576__df441172548743a7861e34c9d53b4b13.pdf 71659.VoR.pdf 2026-04-23T13:49:00.3300640 Output 615048 application/pdf Version of Record true © 2026 The Author(s). This is an open access article under the terms of the Creative Commons Attribution-NonCommercial License. true eng http://creativecommons.org/licenses/by-nc/4.0/
title Diabetes management in people undergoing metabolic-bariatric surgery: A guideline from the Joint British Diabetes Societies for Inpatient Care (JBDS-IP) Group
spellingShingle Diabetes management in people undergoing metabolic-bariatric surgery: A guideline from the Joint British Diabetes Societies for Inpatient Care (JBDS-IP) Group
Jeffrey Stephens
title_short Diabetes management in people undergoing metabolic-bariatric surgery: A guideline from the Joint British Diabetes Societies for Inpatient Care (JBDS-IP) Group
title_full Diabetes management in people undergoing metabolic-bariatric surgery: A guideline from the Joint British Diabetes Societies for Inpatient Care (JBDS-IP) Group
title_fullStr Diabetes management in people undergoing metabolic-bariatric surgery: A guideline from the Joint British Diabetes Societies for Inpatient Care (JBDS-IP) Group
title_full_unstemmed Diabetes management in people undergoing metabolic-bariatric surgery: A guideline from the Joint British Diabetes Societies for Inpatient Care (JBDS-IP) Group
title_sort Diabetes management in people undergoing metabolic-bariatric surgery: A guideline from the Joint British Diabetes Societies for Inpatient Care (JBDS-IP) Group
author_id_str_mv 5219d126f97f8f884bdb622099bd41de
author_id_fullname_str_mv 5219d126f97f8f884bdb622099bd41de_***_Jeffrey Stephens
author Jeffrey Stephens
author2 Jeffrey Stephens
Ketan Dhatariya
Andrew J. Beamish
Dimitri J. Pournaras
Alexander D. Miras
Nader Raafat
Georgia Noble‐Bell
Rachel Cadwallader Buckland
Omar G. Mustafa
format Journal article
container_title Diabetic Medicine
container_volume 43
container_issue 5
publishDate 2026
institution Swansea University
issn 0742-3071
1464-5491
doi_str_mv 10.1111/dme.70281
publisher Wiley
college_str Faculty of Medicine, Health and Life Sciences
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hierarchy_top_title Faculty of Medicine, Health and Life Sciences
hierarchy_parent_id facultyofmedicinehealthandlifesciences
hierarchy_parent_title Faculty of Medicine, Health and Life Sciences
department_str Swansea University Medical School - Biomedical Science{{{_:::_}}}Faculty of Medicine, Health and Life Sciences{{{_:::_}}}Swansea University Medical School - Biomedical Science
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description 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.
published_date 2026-05-01T07:50:24Z
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