Adverse effects during the oral glucose tolerance test in post-bariatric surgery patients

Abstract

Objective: The oral glucose tolerance test (OGTT) is used in the screening of gestational diabetes, in diagnosis of type 2 diabetes in conjunction with fasting blood glucose and glycated hemoglobin. The aim of this study was to examine the incidence and risk factors of adverse effects of OGTT in patients who underwent bariatric surgery, in addition to proposing standardization for ordering the OGTT in these patients. Subjects and methods: This study assessed the incidence of adverse effects in 128 post-bariatric surgery patients who underwent the OGTT. Descriptive and logistic regression analysis were performed, the dependent variables were defined as the presence of signs (tremor, profuse sweating, tachycardia), symptoms (nausea, diarrhea, dizziness, weakness), and hypoglycemia (blood glucose ≤ 50 mg/dL). Results: One hundred and seventeen participants (91.4%) were female; 38 (29.7%) participants were pregnant. High incidence (64.8%) of adverse effects was observed: nausea (38.4%), dizziness (30.5%), weakness (25.8%), diarrhea (23.4%), hypoglycemia (14.8%), tachycardia (14.1%), tremor (13.3%), profuse sweating (12.5%) and one case of severe hypoglycemia (24 mg/dL). The presence of signs was associated with hypoglycemia (OR = 8.1, CI 95% 2.6-25.1). The arterial hypertension persisted as a risk factor for the incidence of signs (OR = 3.6, CI 95% 1.2-11.3). Fasting glucose below 75 mg/dL increased the risk of hypoglycemia during the test (OR = 9.5, CI 95% 2.6-35.1). Conclusion: In this study, high incidence of adverse effects during the OGTT was observed in post-bariatric surgery patients. If these results are confirmed by further studies, the indication and regulation of the OGTT procedure must be reviewed for these patients. Arch Endocrinol Metab.2016;60(4):307-13

Prevalence of type 2 diabetes and impaired fasting glucose in patients affected by rheumatoid arthritis

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Poor clinical response in rheumatoid arthritis is the main risk factor for diabetes development in the short-term: A 1-year, single-centre, longitudinal study

“…Moreover, we did not perform OGTT, the only technique that allow to recognise the presence of IGT, and thus we probably misclassified a small subset of IGT patients as normal, relying only on the absence of T2D and IFG. However, performing OGTT is complex and time-consuming in the rheumatologic setting and may expose the patients to adverse events like nausea, dizziness and severe hypoglycaemia [58]. Finally, the single centre design, although limiting classification bias, may reduce the external validity of our findings.…”

Pregnancy after bariatric surgery: screening for gestational diabetes

“…10 However, test induced dumping syndrome can lead to inaccurate results and pose significant risk: studies have reported reactive hypoglycaemia in 55% 8 and adverse events (including hypoglycaemia) in 65% of women. 11 We suggest that obese women who have had bariatric surgery should be deemed high risk for gestational diabetes and be screened using one of two approaches. The first would be capillary blood glucose monitoring, starting at 14 to 16 weeks of gestation and continuing throughout the pregnancy, similar to the recommendation for women with previous gestational diabetes.…”