Persistent post-bariatric-surgery hypoglycemia: A long-term follow-up reassessment

Ostrovsky, Viviana; Knobler, Hilla; Lazar, Li Or; Pines, Guy; Kuniavsky, Tamila; Cohen, Lee S.; Schiller, Tal; Kirzhner, Alena; Zornitzki, Taiba

doi:10.1016/j.numecd.2023.02.012

Cited by 4 publications

(1 citation statement)

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“…In our study, we observed a higher frequency of hypoglycemia in patients who had undergone BS more than three years ago, in agreement with previous reports [ 6 , 16 ]. A potential explanation for this finding may be related to a greater widening of the gastroyeyunal anastomosis over time, which would enable an increased gastric emptying and a greater incretin and insulin response to equivalent carbohydrate intake.…”

Section: Discussionsupporting

confidence: 93%

Mixed Meal Tolerance Test Versus Continuous Glucose Monitoring for an Effective Diagnosis of Persistent Post-Bariatric Hypoglycemia

Ramos-Leví

Rubio

Matía

et al. 2023

JCM

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Gastric bypass determines an increase in incretin secretion and glucose excursions throughout the day and may sometimes entail the development of severe post-bariatric hypoglycemia (PBH). However, there is no consensus on the gold standard method for its diagnosis. In this study, we evaluated the usefulness of a mixed meal tolerance test (MMTT) and continuous glucose monitoring (CGM) for the diagnosis of PBH, defined as glucose levels <54 mg/dL (3.0 mmol/L). We found that hypoglycemia occurred in 60% of patients after the MMTT and in 75% during CGM, and it was predominantly asymptomatic. The MMTT confirmed the diagnosis of PBH in 88.9%of patients in whom surgery had been performed more than three years ago, in comparison to 36.4% in cases with a shorter postsurgical duration. CGM diagnosed nocturnal asymptomatic hypoglycemia in 70% of patients, and daytime postprandial hypoglycemia in 25% of cases. The mean duration of asymptomatic hypoglycemia was more than 30 min a day. Patients with ≥2% of their CGM readings with hypoglycemia exhibited a higher degree of glucose variability than those with <1% of the time in hypoglycemia. Our results show that the MMTT may be a useful dynamic test to confirm the occurrence of hypoglycemia in a large number of patients with persistent and recurrent PBH during long-term follow-up after gastric bypass. CGM, on its part, helps identify hypoglycemia in the real-world setting, especially nocturnal asymptomatic hypoglycemia, bringing to light that PBH is not always postprandial.

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Section: Discussionsupporting

confidence: 93%