Prevalence of hypoglycaemia in a random population after Roux-en-Y gastric bypass after a meal test

Abstract

Objective Roux-en-Y gastric bypass (RYGB) is an effective way to induce sustainable weight loss and can be complicated by postprandial hyperinsulinaemic hypoglycaemia (PHH). To study the prevalence and the mechanisms behind the occurrence of hypoglycaemia after a mixed meal tolerance test (MMTT) in patients with primary RYGB. Design This is a cross-sectional study of patients 4 years after primary RYGB. Methods From a total population of 550 patients, a random sample of 44 patients completed the total test procedures. A standardized mixed meal was used as stimulus. Venous blood samples were collected at baseline, every 10 min during the first half hour and every 30 min until 210 min after the start. Symptoms were assessed by questionnaires. Hypoglycaemia is defined as a blood glucose level below 3.3 mmol/L. Results The prevalence of postprandial hypoglycaemia was 48% and was asymptomatic in all patients. Development of hypoglycaemia was more frequent in patients with lower weight at surgery (P = 0.045), with higher weight loss after surgery (P = 0.011), and with higher insulin sensitivity calculated by the homeostasis model assessment indexes (HOMA2-IR, P = 0.014) and enhanced beta cell function (insulinogenic index at 20 min, P = 0.001). Conclusion In a randomly selected population 4 years after primary RYGB surgery, 48% of patients developed a hypoglycaemic event during an MMTT without symptoms, suggesting the presence of hypoglycaemia unawareness in these patients. The findings in this study suggest that the pathophysiology of PHH is multifactorial.

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].…”

Patient involvement to inform the design of a clinical trial in postbariatric hypoglycaemia

“…Bariatric surgery is one of the most effective interventions to achieve long-term weight loss in patients with severe obesity, but frequently leads to serious side effects [1][2][3]. One of them is postprandial hypoglycaemia (PBH), previously referred to as late-dumping, affecting in standardized test settings about 50% of patients with a gastric bypass [4][5][6] although it is frequently undiagnosed [7]. This may lead to a reduced quality of life [8], secondary weight gain [9,10] and may even be associated with an increased mortality [11][12][13].…”

“…The measurement of hypoglycaemic episodes by continuous glucose measurement systems appears to accurately depict real-life glucose level variation and may give an objective measurement of the metabolic effects of an intervention aiming to alleviate symptomatic metabolic disorders [24]. However, it is unclear how relevant it is for patients with symptomatic hypoglycaemic episodes to measure merely metabolic changes, since some hypoglycaemic episodes may not be recognized [7,25,26] and have varying symptomatic presentation, especially when occurring frequently or during the night [7]. Measuring the frequency of hypoglycaemic episodes alone without consideration of their severity and patient-reported symptoms, seems inadequate to reflect patients' needs.…”

Patient Involvement to Inform the Design of a Clinical Trial in Postbariatric Hypoglycemia

“…Bariatric surgery is one of the most effective interventions to achieve long-term weight loss in patients with severe obesity, but frequently leads to serious side effects (1)(2)(3). One of them is postprandial hypoglycemia (PBH), previously referred to as late-dumping, affecting in standardized test settings about 50% of patients with a gastric bypass(4-6) although it is frequently undiagnosed (7). This may lead to a reduced quality of life (8), secondary weight gain (9,10) and may even be associated with an increased mortality (11)(12)(13).…”

“…The measurement of hypoglycemic episodes by continuous glucose measurement systems appears to accurately depict real-life glucose level variation and may give an objective measurement of the metabolic effects of an intervention aiming to alleviate symptomatic metabolic disorders (24). However, it is unclear how relevant it is for patients with symptomatic hypoglycemic episodes to measure merely metabolic changes, since some hypoglycemic episodes may not be recognized (7,25,26) and have varying symptomatic presentation, especially when occurring frequently or during the night (7). Measuring the frequency of hypoglycemic episodes alone without consideration of their severity and patient-reported symptoms seem inadequate to re ect patients' needs.…”