Incidence and Predictors of Hypoglycemia 1 Year After Laparoscopic Sleeve Gastrectomy

Belligoli, Anna; Sanna, Marta; Serra, Roberto; Fabris, Roberto; Prà, Chiara Dal; Conci, Scilla; Fioretto, Paola; Prevedello, Luca; Foletto, Mirto; Vettor, Roberto; Busetto, Luca

doi:10.1007/s11695-017-2742-2

Cited by 36 publications

(18 citation statements)

References 30 publications

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“…This way, our study population’s hypoglycemia status is well-characterized as opposed to large cohort or register studies, which define hypoglycemia by past diagnosis. In contrast to previous studies, age, sex, and fasting glucose did not distinguish patients with and without hypoglycemia in our study [ 11 , 16 , 27 ]. Higher preoperative insulin sensitivity may be another risk factor but was not assessed in this cohort [ 11 ].…”

Section: Discussioncontrasting

confidence: 99%

“…Known risk factors for hypoglycemia in postbariatric patients are younger age, female gender, greater postoperative loss of weight, and pre-operative high insulin sensitivity [ 14 – 16 ]. The diagnosis of hypoglycemia is often demanding and requires fulfillment of Whipple’s triad often established with provocation testing [ 13 , 14 , 16 – 18 ]. These cumbersome and cost-intense tests require constant observation of the patient for several hours by health care professionals.…”

Section: Introductionmentioning

confidence: 99%

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Predictors of Postprandial Hypoglycemia After Gastric Bypass Surgery: a Retrospective Case-Control Study

2021

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Background Postprandial hypoglycemia after bariatric surgery is an exigent disorder, often impacting the quality of life. Distinguishing clinically relevant hypoglycemic episodes from symptoms of other origin can be challenging. Diagnosis is demanding and often requires an extensive testing such as prolonged glucose tolerance or mixed-meal test. Therefore, we investigated whether baseline parameters of patients after gastric bypass with suspected hypoglycemia can predict the diagnosis. Methods We analyzed data from 35 patients after gastric bypass with suspected postprandial hypoglycemia and performed a standardized mixed-meal test. Hypoglycemia was defined by the appearance of typical symptoms, low plasma glucose, and relief of symptoms following glucose administration. Parameters that differed in patients with and without hypoglycemia during MMT were identified and evaluated for predictive precision using receiver operating characteristic (ROC) areas under the curve (AUC). Results Out of 35 patients, 19 (54%) developed symptomatic hypoglycemia as a result of exaggerated insulin and C-peptide release in response to the mixed-meal. Hypoglycemic patients exhibited lower glycosylated hemoglobin A1c (HbA1c) and higher absolute and relative weight loss from pre-surgery to study date. HbA1c and absolute weight loss alone could achieve acceptable AUCs in ROC analyses (0.76 and 0.72, respectively) but a combined score of absolute weight loss divided by HbA1c (0.78) achieved the best AUC. Conclusions HbA1c and weight loss differed in patients with and without symptomatic hypoglycemia during mixed-meal test. These baseline parameters could be used for screening of postprandial hypoglycemia in patients after gastric bypass and may facilitate the selection of patients requiring further evaluation. Graphical abstract

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Section: Discussioncontrasting

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Predictors of Postprandial Hypoglycemia After Gastric Bypass Surgery: a Retrospective Case-Control Study

2021

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“…True prevalence of BS-related hypoglycemia is unknown, partly due to lack of consensus in defining and diagnosing this condition [ 47 – 49 ]. Reactive hypoglycemia is generally considered to be more common after RYGB than SG, despite the recent report of a high hypoglycemia rate 1-year after SG [ 50 ]. A 1-year randomized trial comparing the effect of SG with that of RYGB showed that hypoglycemic events measured with continuous glucose monitoring was not different between the two procedures (29% vs. 14%) [ 51 ].…”

Section: Specific Nutritional Problems After Bsmentioning

confidence: 99%

Diet approach before and after bariatric surgery

Bettini

Belligoli

Fabris

2020

Rev Endocr Metab Disord

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Bariatric surgery (BS) is today the most effective therapy for inducing long-term weight loss and for reducing comorbidity burden and mortality in patients with severe obesity. On the other hand, BS may be associated to new clinical problems, complications and side effects, in particular in the nutritional domain. Therefore, the nutritional management of the bariatric patients requires specific nutritional skills. In this paper, a brief overview of the nutritional management of the bariatric patients will be provided from pre-operative to post-operative phase. Patients with severe obesity often display micronutrient deficiencies when compared to normal weight controls. Therefore, nutritional status should be checked in every patient and correction of deficiencies attempted before surgery. At present, evidences from randomized and retrospective studies do not support the hypothesis that pre-operative weight loss could improve weight loss after BS surgery, and the insurance-mandated policy of a preoperative weight loss as a pre-requisite for admission to surgery is not supported by medical evidence. On the contrary, some studies suggest that a modest weight loss of 5–10% in the immediate preoperative period could facilitate surgery and reduce the risk of complications. Very low calories diet (VLCD) and very low calories ketogenic diets (VLCKD) are the most frequently used methods for the induction of a pre-operative weight loss today. After surgery, nutritional counselling is recommended in order to facilitate the adaptation of the eating habits to the new gastro-intestinal physiology. Nutritional deficits may arise according to the type of bariatric procedure and they should be prevented, diagnosed and eventually treated. Finally, specific nutritional problems, like dumping syndrome and reactive hypoglycaemia, can occur and should be managed largely by nutritional manipulation. In conclusion, the nutritional management of the bariatric patients requires specific nutritional skills and the intervention of experienced nutritionists and dieticians.

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“…The precise incidence and prevalence of PBH is unknown, due to differences in diagnostic criteria, the challenges of self-reporting of symptoms which are often non-specific, and the high rates of asymptomatic low glucose values. Severe hypoglycemia requiring hospitalization occurs in less than 1% of individuals; 36 however, estimates suggest that symptomatic hypoglycemia occurs in 10-30% of individuals, 37,38 and occurs after both RYGB and vertical sleeve gastrectomy (SG), with similar presentation and spectrum of severity. 39 There are no published data on the prevalence of hypoglycemia occurring after other upper gastrointestinal surgeries such as Nissen fundoplication or esophageal or gastric procedures, beyond case reports.…”

Section: Incidence/prevalencementioning

confidence: 99%

<p>Hypoglycemia After Upper Gastrointestinal Surgery: Clinical Approach to Assessment, Diagnosis, and Treatment</p>

Sheehan¹,

Patti²

2020

DMSO

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Incidence and Predictors of Hypoglycemia 1 Year After Laparoscopic Sleeve Gastrectomy

Abstract: These findings confirm the high incidence of post-prandial hypoglycemia 1 year after LSG. Hypoglycemia is more frequent in younger patients with lower fasting glucose and higher triglyceride levels before surgery.

Cited by 36 publications

References 30 publications

Predictors of Postprandial Hypoglycemia After Gastric Bypass Surgery: a Retrospective Case-Control Study

Predictors of Postprandial Hypoglycemia After Gastric Bypass Surgery: a Retrospective Case-Control Study

Diet approach before and after bariatric surgery

<p>Hypoglycemia After Upper Gastrointestinal Surgery: Clinical Approach to Assessment, Diagnosis, and Treatment</p>

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