Utility of continuous glucose monitoring following gastrectomy

Abstract

Background Glucose fluctuation after gastrectomy represented by dumping syndrome is a well-known post-gastrectomy syndrome that negatively impacts patient quality of life. However, the current methods of post-gastrectomy glucose monitoring do not comprehensively capture the postoperative blood glucose fluctuations that characterize this. Methods We used a continuous glucose monitoring (CGM) system to document the glycemic profiles of patients undergoing gastrectomy and compared these between patients undergoing distal gastrectomy (DG) and total gastrectomy (TG). To evaluate post-gastrectomy syndromes, including dumping syndrome, we used the Post-gastrectomy Syndrome Assessment Scale 37-item questionnaire. The glycemic profiles were also compared using this tool. Results We studied 57 patients who had undergone DG and 13 who had undergone TG between September 2017 and September 2019. Our results revealed larger diurnal glycemic variability and longer periods of nocturnal hypoglycemia after gastrectomy. The dumping score was worse in the TG than in the DG group (TG 2.4 ± 1.4 vs. DG 1.3 ± 1.2, P = 0.0061). Importantly, 30 of 57 DG patients (52.6%) and 5 of 13 TG patients (38.5%) experienced postprandial hypoglycemia following hyperglycemia without hypoglycemic symptoms. There was no correlation between the dumping symptom score and glycemic variability (ρ = 0.0545, P = 0.6662). Conclusions CGM demonstrated diurnal glycemic variability and nocturnal hypoglycemia in patients undergoing gastrectomy. Because some hypoglycemic patients did not develop symptoms and glycemic variability was not necessarily associated with dumping symptom, dumping syndrome must only partially explain the postoperative glucose fluctuations.

Preliminary prospective study of real-time post-gastrectomy glycemic fluctuations during dumping symptoms using continuous glucose monitoring

“…To our knowledge, this is the first exploratory study of real-time changes in glucose profiles when a dumping symptom actually occurs after gastrectomy using CGM and daily recording of diet and symptoms. Although a few studies have demonstrated continuous glucose profiles using CGM after GC surgery, with most simply measuring the glucose fluctuations, the occurrence of dumping symptoms over time has not previously been examined[ 22 - 24 ]. Results of the present study indicated glucose fluctuations to be involved in the onset of late dumping as well as early dumping symptoms after standard gastrectomy for GC.…”

Postprandial Asymptomatic Glycemic Fluctuations after Gastrectomy for Gastric Cancer Using Continuous Glucose Monitoring Device

“…Additionally, TG-RY showed lower postprandial glycemic levels following glucose spikes, and the hypoglycemic period with glucose <70 mg/dL during CGM measurement was longer in the TG-RY group than in the other three procedure groups. Using CGM, Kubota et al demonstrated nocturnal hypoglycemia after TG-RY in gastric cancer [ 28 ]. In addition, several hypoglycemic episodes after RY gastric bypass in obese patients have been reported to be asymptomatic [ 29 ].…”

Postprandial Changes in Gastrointestinal Hormones and Hemodynamics after Gastrectomy in Terms of Early Dumping Syndrome

“…Instead, among the clinical patient factors, distal gastrectomy was an independent factor associated with “non-dumper” (dumping score of 4 or below) and the degrees of postprandial increases in blood glucose, GLP-1, and GLP-2 levels and heart rate were significantly more prominent in patients with total gastrectomy than those in patients with distal gastrectomy. Previous studies reported higher incidences of early dumping syndrome in patients who underwent total gastrectomy than those in patients who underwent distal gastrectomy due to more accelerated nutrient delivery into the small intestine [ 1 29 ]. To our knowledge, this is the first study to identify a significant difference in the degree of postprandial changes in GI hormones and hemodynamics between patients who underwent distal or total gastrectomy.…”