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. 2019 Jul;8(7):969-978.
doi: 10.1530/EC-19-0268.

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

Marloes Emous  1 , Merel van den Broek  1 , Ragnhild B Wijma  1 , Loek J M de Heide  1 , Gertjan van Dijk  2 , Anke Laskewitz  3 , Erik Totté  1 , Bruce H R Wolffenbuttel  4 , André P van Beek  1   4
Affiliations

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

Marloes Emous et al. Endocr Connect. 2019 Jul.

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.

Keywords: bariatric surgery; gastric bypass; hypoglycaemia; incretins; prevalence.

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Figures

Figure 1
Figure 1
CONSORT flow diagram.
Figure 2
Figure 2
Glucose and insulin levels in patients with and without a hypoglycaemic event. Data are mean ± s.e.m. *P value <0.05, **P value <0.01, ***P value <0.001. Black line: patients without hypoglycaemia (glucose >3.3 mmol/L). Grey line: patients with hypoglycaemia (glucose ≤3.3 mmol/L).
Figure 3
Figure 3
Changes in gut hormones from baseline (percentage change) of various gut hormones in patients with and without a hypoglycaemic event. Data are mean ± s.e.m. Black line: patients without hypoglycaemia (glucose >3.3 mmol/L). Grey line: patients with hypoglycaemia (glucose ≤3.3 mmol/L).
See this image and copyright information in PMC

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