Following gastric bypass surgery, many patients will still need metformin or glipizide (Glucotrol). Is there any evidence that one class of oral antidiabetic agents is better absorbed than another? — Judith Cooper, CRNP, Lapine, Ala.

The effects of bariatric surgery on drug absorption continue to be poorly understood. There is a lack of published reports in this area, and the quality of the data available varies. Many reports combine data from patients who received different procedures (e.g., laparoscopic adjustable gastric band, laparoscopic sleeve gastrectomy, Roux-en-Y gastric bypass, and biliopancreatic diversion with or without duodenal switch), making the accurate interpretation of the results impossible.

Bariatric surgery often results in the resolution of type 2 diabetes. Thus, the recommendation is for close and continued monitoring of a patient’s clinical response to his or her oral hypoglycemic agents, anticipating that the need for medication very likely will decrease. In addition to monitoring for any symptoms of hypoglycemia, monitor blood sugar and hemoglobin A1c values, and use these assessments to assist in clinical decision making regarding drug dosing.— Eileen F. Campbell, MSN, CRNP (153-03)