Acarbose Improves Hypoglycaemia Following Gastric Bypass Surgery Without Increasing Glucagon-Like Peptide 1 Levels

Valderas, Juan P.; Ahuad, Jessica; Rubio, Lorena; Escalona, Manuel; Pollak, Felipe; Maíz, Alberto

doi:10.1007/s11695-011-0581-0

Cited by 84 publications

(59 citation statements)

References 20 publications

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“…Several treatments have been proposed in the literature; these involve acarbose (24,25), calcium channel antagonists (nifedipine and verapamil) (26), the somatostatin analogues octreotide (27) and pasireotide (28), the b-cell inhibitor diazoxide (29), and finally and ultimately, partial pancreatectomy (30). Glucagon has been tried as infusion but has not been proven to be useful perhaps because of its concomitantly high levels of insulin (31).…”

Section: Introductionmentioning

confidence: 99%

Hypoglycemia in everyday life after gastric bypass and duodenal switch

Abrahamsson

Engström

Sundbom

et al. 2015

European Journal of Endocrinology

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Design: Gastric bypass (GBP) and duodenal switch (DS) in morbid obesity are accompanied by marked metabolic improvements, particularly in glucose control. In recent years, episodes of severe late postprandial hypoglycemia have been increasingly described in GBP patients; data in DS patients are scarce. We recruited three groups of subjects; 15 GBP, 15 DS, and 15 non-operated overweight controls to examine to what extent hypoglycemia occurs in daily life. Methods: Continuous glucose monitoring (CGM) was used during 3 days of normal activity. The glycemic variability was measured by mean amplitude of glycemic excursion and continuous overall net glycemic action. Fasting blood samples were drawn, and the patients kept a food and symptom log throughout the study. Results: The GBP group displayed highly variable CGM curves, and 2.9% of their time was spent in hypoglycemia (!3.3 mmol/l, or 60 mg/dl). The DS group had twice as much time in hypoglycemia (5.9%) and displayed CGM curves with little variation as well as lower HbA1c levels (29.3 vs 35.9 mmol/mol, P!0.05). Out of a total of 72 hypoglycemic episodes registered over the 3-day period, 70 (97%) occurred in the postprandial state and only about one-fifth of the hypoglycemic episodes in the GBP and DS groups were accompanied by symptoms. No hypoglycemias were seen in controls during the 3-day period. Conclusion: Both types of bariatric surgery induce marked, but different, changes in glucose balance accompanied by frequent, but mainly unnoticed, hypoglycemic episodes. The impact and mechanism of hypoglycemic unawareness after weight-reduction surgery deserves to be clarified.

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Section: Introductionmentioning

confidence: 99%

Hypoglycemia in everyday life after gastric bypass and duodenal switch

Abrahamsson

Engström

Sundbom

et al. 2015

European Journal of Endocrinology

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“…A much larger number of patients might suffer from vague symptoms and are therefore not being diagnosed with post-gastric bypass hypoglycemia. Subsequently, they are not offered adequate treatment, which might consist of dietary modifications [18,28], acarbose [29][30][31], octreotide [15,32], verapamil [33] or diazoxide [34] as drug therapy or surgical interventions such as secondary bypass banding [35,36], bypass reversal [37,38] or pancreatic resection [24][25][26][27]39]. In our study, CGM provided better detection rates for post-RYGB hypoglycemia compared with MMT.…”

Section: Discussionmentioning

confidence: 68%

Hypoglycemia after Roux-En-Y gastric bypass: detection rates of continuous glucose monitoring (CGM) versus mixed meal test

Kefurt

Langer

Schindler

et al. 2015

Surgery for Obesity and Related Diseases

115

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“…However, SFU usage carries a greater risk of inducing hypoglycemia and weight regain compared to usage of oral insulin-sensitizing agents [47,48]. Given the increases in insulin secretory capacity following bariatric surgery, additional intervention with SFUs may induce hyperinsulinemic hypoglycemia and precipitate symptoms of dumping syndrome [49]. SFUs must therefore be used with caution.…”

Section: Biguanides Thiazolidinediones (Tzds) and Sulfonylureas (Sfus)mentioning

confidence: 99%

Clinical Management of Type 2 Diabetes Mellitus after Bariatric Surgery

Khanna

Kashyap

2015

Curr Atheroscler Rep

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Bariatric surgery has emerged as an effective treatment for type 2 diabetes in the setting of obesity, with recent clinical trials demonstrating biochemical remission (i.e., euglycemia) in up to 40 % of subjects at 3 years post-surgery. Conversely, these trials also highlight that a significant proportion of individuals undergoing bariatric surgery experience residual diabetes (i.e., they do not achieve remission or experience diabetes recurrence). The management of residual diabetes following surgery requires personalized attention, yet limited evidence exists on which to base clinical decisions. Hence, we aim to review the evidence that does exist and propose clinical management strategies in patients with persistent hyperglycemia following bariatric surgery.

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Acarbose Improves Hypoglycaemia Following Gastric Bypass Surgery Without Increasing Glucagon-Like Peptide 1 Levels

Cited by 84 publications

References 20 publications

Hypoglycemia in everyday life after gastric bypass and duodenal switch

Hypoglycemia in everyday life after gastric bypass and duodenal switch

Hypoglycemia after Roux-En-Y gastric bypass: detection rates of continuous glucose monitoring (CGM) versus mixed meal test

Clinical Management of Type 2 Diabetes Mellitus after Bariatric Surgery

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