Incidence of Hypoglycemia After Gastric Bypass vs Sleeve Gastrectomy: A Randomized Trial

Abstract

We show that reactive hypoglycemia is no less common after SG and is not a safer option than RYGB, but RYGB is associated with more severe hypoglycemic episodes. This is likely due to the lack of improvement of β-cell sensitivity to changes in circulating glucose after RYGB, which determines an inappropriately high insulin secretion.

Symptomatic and Asymptomatic Hypoglycemia Post Three Different Bariatric Procedures: A Common and Severe Complication

“…These findings are in accordance with two previous studies using questionnaires (13,28). In contrast, MMTT was found in our study to be much more in the RYGB procedure group compared with the SG group and demonstrated that the first group exhibited a more prolonged high insulin secretion even when glucose concentrations were falling (15). Other mechanisms that can contribute to the higher rate of severe PBH after bypass interventions include: accelerated nutrient emptying from the stomach pouch into the intestine (roux limb), leading to increased postprandial hyperglycemic peak and subsequently enhanced enteroinsulin axis activity, mediated by massive GLP-1 secretion; altered bile acid metabolism, and diminished insulin clearance (9).…”

“…Only a minority of individuals in our study reported symptoms suggestive of hypoglycemia based on questionnaires. Furthermore, during MMTT-DOI:10.4158/EP-2019-0185 © 2019 AACE.induced hypoglycemia, only a quarter complained of symptoms even when experiencing severe hypoglycemia.Our findings are in accordance with previous studies(15,17) and are supported by the intriguing findings of Abramsson et al that examined twelve non-diabetic obese patients with hyperinsulinemic-hypoglycemic clamp before and 6 months post gastric-bypass procedure. The study demonstrated significant attenuation of postsurgery hypoglycemic symptoms and marked reduction in glucagon, cortisol, catecholamines levels and in the sympathetic response to hypoglycemia(27).Hypoglycemia unawareness may also provide a plausible mechanism contributing to the unexplained previous reports of a higher rate of car accidents, suicide attempts and even mortality in individuals who underwent BS(2)(3)(4)(6)(7)(8).…”

“…The ability to assess events not only postprandial but also during fasting conditions especially during nighttime. These results are in agreement with previous studies(15)(16)(17) and suggest that these two methods are important and complementary and should be used much more often and considered as part of the standard evaluation after BS. In many countries including Israel, the three currently leading procedures performed in morbid obesity are the narrowing operation (i.e.…”

“…In contrast, studies that used provocative tests such as OGTT, MMTT or studies that used CGM have found a higher prevalence of PBH (13)(14)(15)(16)(17). In a recent study by Capristo et al that included 120 patients who were randomized to RYGB or SG, the authors showed that during an OGTT, 29% in the RYGB group and 14% in the SG group developed hypoglycemia (15).…”

Brunner’s Gland Hyperplasia in a Patient after Roux-Y Gastric Bypass: An Important Pitfall in GLP-1 Receptor Imaging

“…Postbariatric hypoglycaemia (PBH), formerly also described as late dumping, is a significant but under-recognized medical complication after bariatric surgery [1,2]. Depending on the diagnostic test, recent data suggest higher incidence rates than previously thought, occurring in up to 48% of patients after Roux-Y gastric bypass and up to 25% of patients after sleeve gastrectomy [3][4][5].…”