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CGM reveals variations following bariatric surgery

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SAN FRANCISCO — Continuous glucose monitoring showed frequent glycemic variations in patients following bariatric surgery, according to research presented at the American Diabetes Association’s 74th Scientific Sessions.

This method that identified marked alterations in patients who had undergone gastric bypass (GBP) and biliopancreatic diversion with duodenal switch (DS) could reveal potentially dangerous states of hypoglycemia that often go unnoticed.

“Both post-surgery groups exhibit a significant amount of time in hypoglycemia,” Niclas Abrahamsson, MD, of the Department of Medical Sciences, University of Uppsala, Sweden, said during his presentation. “Post-GBP patients have very variable glucose curves and post-DS patients, non-variable glucose curves, which is probably related to different glucose absorption abilities post-surgery.”

Abrahamsson and colleagues used continuous glucose monitoring (CGM) in 15 GBP patients (12 women, mean BMI=33), 15 DS patients (7 women, BMI=31) and 15 patients in a control group (12 women, mean BMI=31) over 3 days. The researchers quantified fasting glucometabolic and glucoregulatory variables.

Variations in CGM curves were high for patients who underwent GBP and low for patients who underwent DS, with control patients at intermediate levels, as seen in mean amplitude of glycemic excursions (3.2, 1.5 and 2.4, respectively) and continuous overall net glycemic action (2.1, 0.5 and 0.7, respectively).

Mean glucose level and HbA1c were lowest in DS (4.7 mmol/L and 27.9 mmol/mol) compared with GBP (6.0 mmol/L and 35.9 mmol/L) and controls (5.9 mmol/L and 37.9 mmol/L).

Patients with GBP spent 42 min/24 hours with glucose <3.3 mmol/L, those with DS clocked 85 min/24 hours and controls, none; additionally, the GBP group showed 21 min/24 hours with glucose <2.8 mmol/l and the DS group, 39min/24 hours.

GBP patients had 2.3 hypoglycemic episodes per 24 hours total and DS patients 3.2 episodes in the same timeframe. However, one or more hypoglycemic episodes was identified by only 36% of GBP patients and 33% of DS patients.

“The clinical significance would be that one should be alert of any hypoglycemic symptoms in continuous glucose monitoring in postprandial stages in this group,” Abrahamsson said.

For More Information: Abrahamsson N. Abstract 102-OR. Presented at: American Diabetes Association’s 74th Scientific Sessions; June 13-17, 2014; San Francisco.

Disclosures: Abrahamsson reports no relevant disclosures.