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Multicenter Study
. 2021 Oct;17(10):1787-1798.
doi: 10.1016/j.soard.2021.04.021. Epub 2021 May 19.

Postbariatric hypoglycemia: symptom patterns and associated risk factors in the Longitudinal Assessment of Bariatric Surgery study

Laura E Fischer  1 , Bruce M Wolfe  2 , Nora Fino  2 , Miriam R Elman  3 , David R Flum  4 , James E Mitchell  5 , Alfons Pomp  6 , Walter J Pories  7 , Jonathan Q Purnell  2 , Mary-Elizabeth Patti  8 ; LABS Investigators
Collaborators, Affiliations
Multicenter Study

Postbariatric hypoglycemia: symptom patterns and associated risk factors in the Longitudinal Assessment of Bariatric Surgery study

Laura E Fischer et al. Surg Obes Relat Dis. 2021 Oct.

Abstract

Background: Postbariatric hypoglycemia (PBH) can be a devastating complication for which current therapies are often incompletely effective. More information is needed regarding frequency, incidence, and risk factors for PBH.

Objectives: To examine hypoglycemia symptoms following Roux-en-Y gastric bypass (RYGB) and laparoscopic adjustable gastric banding (LAGB) and baseline and in-study risk factors.

Setting: Multicenter, at 10 US hospitals in 6 geographically diverse clinical centers.

Methods: A prospective, longitudinal cohort study of adults undergoing RYGB or LAGB as part of clinical care between 2006 and 2009 were recruited and followed until January 31, 2015, with baseline and annual postoperative research assessments. We analyzed baseline prevalence and post-operative incidence and frequency of self-reported hypoglycemia symptoms as well as potential preoperative risk factors.

Results: In all groups, postoperative prevalence of hypoglycemia symptoms was 38.5%. Symptom prevalence increased postoperatively from 2.8%-36.4% after RYGB in patients without preoperative diabetes (T2D), with similar patterns in prediabetes (4.9%-29.1%). Individuals with T2D had higher baseline hypoglycemia symptoms (28.9%), increasing after RYGB (57.9%). Hypoglycemia symptoms were lower after LAGB, with 39.1% reported hypoglycemia symptoms at only 1 postoperative visit with few (4.0%) having persistent symptoms at 6 or more annual visits. Timing of symptoms was not restricted to the postprandial state. Symptoms of severe hypoglycemia were reported in 2.6-3.6% after RYGB. The dominant risk factor for postoperative symptoms was preoperative symptoms; additionally, baseline selective serotonin (SSRI) and serotonin-norepinephrine (SNRI) reuptake inhibitor use was also associated with increased risk in multivariable analysis. Weight loss and regain were not related to hypoglycemia symptom reporting.

Conclusion: Hypoglycemia symptoms increase over time after RYGB, particularly in patients without diabetes. In a small percentage, symptoms can be persistent or severe and require hospitalization. Preoperative hypoglycemia symptoms and SSRI/SNRI use in RYGB patients without diabetes is associated with increased risk of symptoms.

Keywords: Bariatric surgery; Diabetes; Hypoglycemia; Laparoscopic adjustable gastric band; Roux-en-Y gastric bypass; SNRI; SSRI.

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Figures

Fig. 1.
Fig. 1.
Baseline and any reported postoperative hypoglycemia (%) in patients undergoing Roux-en-Y gastric bypass (RYGB) or laparoscopic adjustable gastric band (LAGB), stratified by preoperative diabetes status.
Fig. 2.
Fig. 2.
Percentage of patients who reported any postoperative hypoglycemia at each follow-up visit, stratified by preoperative diabetes status following Roux-en-Y gastric bypass (RYGB, upper graph) or laparoscopic adjustable gastric band (LAGB, lower graph).
Fig. 3.
Fig. 3.
Percentage of Roux-en-Y gastric bypass (RYGB) patients who reported a hospital or emergency room (ER) visit for low blood sugar in the 3 months prior to survey, stratified by preoperative diabetes status.
Fig. 4.
Fig. 4.
Percentage of Roux-en-Y gastric bypass (RYGB) patients reporting timing of low blood sugar with regard to meals (<4 hr, >4 hr, or unrelated), stratified by preoperative diabetes status.
Fig. 5.
Fig. 5.
Multivariable models for postoperative hypoglycemia after Roux-en-Y gastric bypass (RYGB) (A) or laparoscopic adjustable gastric band (LAGB) (B).
See this image and copyright information in PMC

References

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