TY - JOUR

T1 - Relationship between biochemical and symptomatic hypoglycemia after RYGB. Responses to a mixed meal test

T2 - a case-control study

AU - Søeby, Mette

AU - Nielsen, Joan B.

AU - Pedersen, Steen B.

AU - Gribsholt, Sigrid B.

AU - Holst, Jens J.

AU - Richelsen, Bjørn

PY - 2020

Y1 - 2020

N2 - Background: Postprandial hypoglycemia is a relatively common complication after Roux-en-Y gastric bypass (RYGB). The cause remains incompletely understood, and the association between biochemical hypoglycemia and hypoglycemic symptoms is unclear.Objectives: To evaluate the association between postprandial hormonal responses and biochemical and symptomatic hypoglycemia after RYGB.Setting: University Hospital, Denmark.Methods: A case-control study with 3 groups: (1) RYGB group with postprandial hypoglycemic symptoms (HS), n = 13; (2) RYGB-group with no symptoms of hypoglycemia (NHS), n = 13; and (3) nonoperated body mass index-matched controls (CON), n = 7. Plasma glucose (PG) and hormonal responses (insulin, glucagon-like peptide-1, gastric inhibitory polypeptide, glucagon) were measured after a mixed meal test (MMT), and hypoglycemic symptoms were determined by a questionnaire. The primary outcomes were differences in subjective and biochemical responses related to hypoglycemia among the 3 groups.Results: Nadir PG was lower (3.1 versus 4.0 mmol/L (56 versus 72 mg/dL); P = .0002) and peak insulin higher in HS than NHS patients (1073 versus 734 pmol/L; P = .0499). Of the 13 patients with a peak insulin >850 pmol/L, 8 patients developed symptoms whereas only 2 out of the 13 patients with peak insulin 3 mmol/L (54 mg/dL) revealed a difference in both peak insulin (1138 versus 760 pmol/L; P = .042) and peak glucagon-like peptide-1 (182 versus 86 pmol/L; P = .016) concentrations.Conclusions: Patients with HS had lower nadir PG and higher insulin responses than NHS patients after MMT. Regarding PG, PG

AB - Background: Postprandial hypoglycemia is a relatively common complication after Roux-en-Y gastric bypass (RYGB). The cause remains incompletely understood, and the association between biochemical hypoglycemia and hypoglycemic symptoms is unclear.Objectives: To evaluate the association between postprandial hormonal responses and biochemical and symptomatic hypoglycemia after RYGB.Setting: University Hospital, Denmark.Methods: A case-control study with 3 groups: (1) RYGB group with postprandial hypoglycemic symptoms (HS), n = 13; (2) RYGB-group with no symptoms of hypoglycemia (NHS), n = 13; and (3) nonoperated body mass index-matched controls (CON), n = 7. Plasma glucose (PG) and hormonal responses (insulin, glucagon-like peptide-1, gastric inhibitory polypeptide, glucagon) were measured after a mixed meal test (MMT), and hypoglycemic symptoms were determined by a questionnaire. The primary outcomes were differences in subjective and biochemical responses related to hypoglycemia among the 3 groups.Results: Nadir PG was lower (3.1 versus 4.0 mmol/L (56 versus 72 mg/dL); P = .0002) and peak insulin higher in HS than NHS patients (1073 versus 734 pmol/L; P = .0499). Of the 13 patients with a peak insulin >850 pmol/L, 8 patients developed symptoms whereas only 2 out of the 13 patients with peak insulin 3 mmol/L (54 mg/dL) revealed a difference in both peak insulin (1138 versus 760 pmol/L; P = .042) and peak glucagon-like peptide-1 (182 versus 86 pmol/L; P = .016) concentrations.Conclusions: Patients with HS had lower nadir PG and higher insulin responses than NHS patients after MMT. Regarding PG, PG

KW - Roux-en-Y gastric bypass

KW - Hypoglycemia

KW - Insulin

KW - Glucagon-like peptide-1

KW - Mixed meal test

KW - GASTRIC-BYPASS-SURGERY

KW - BARIATRIC SURGERY

KW - ORAL GLUCOSE

KW - NEUROGLYCOPENIA

KW - PREVALENCE

KW - SECRETION

KW - INCRETIN

KW - GLP-1

U2 - 10.1016/j.soard.2020.04.024

DO - 10.1016/j.soard.2020.04.024

M3 - Journal article

C2 - 32576515

VL - 16

SP - 1179

EP - 1185

JO - Surgery for Obesity and Related Diseases

JF - Surgery for Obesity and Related Diseases

SN - 1550-7289

IS - 9

ER -