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Low plasma glucose before bariatric surgery may predict postprandial hypoglycemia
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Postprandial hypoglycemia after Roux-en-Y gastric bypass and laparoscopic sleeve gastrectomy may be predicted by low presurgery plasma glucose concentrations, high insulin sensitivity and better beta-cell glucose sensitivity, study data show.
Monica Nannipieri, MD, of the department of clinical and experimental medicine at the University of Pisa in Italy, and colleagues evaluated adults without diabetes who underwent Roux-en-Y gastric bypass (RYGB; n = 21) or laparoscopic sleeve gastrectomy (n = 11) who self-report postprandial hypoglycemia and controls (RYGB, n = 13; laparoscopic sleeve gastrectomy, n = 40) who never experienced spontaneous or oral glucose tolerance test-induced hypoglycemia over 24 months after surgery. Participants underwent surgery from 2013 to 2014.
Three-hour OGTTs were analyzed for all participants before and after surgery.
Compared with the group without postprandial hypoglycemia, the postprandial hypoglycemia group had higher BMI before RYGB (P = .002) and laparoscopic sleeve gastrectomy (P = .08). For both surgery groups, fasting plasma glucose and glucose nadir levels were lower in the postprandial hypoglycemia group before surgery compared with the group without postprandial hypoglycemia.
Compared with the group without postprandial hypoglycemia, the postprandial hypoglycemia group had higher presurgery insulin sensitivity (RYGB, P = .001; laparoscopic sleeve gastrectomy, P = .05) and higher beta-cell glucose sensitivity (P = .02 for both surgery types). After surgery, insulin sensitivity and beta-cell glucose sensitivity improved in all participants.
“After both surgeries the shape of the glucose curve shows an earlier glucose peak followed by a quicker decline in glycemia, an expected consequence of the anatomical changes,” the researchers wrote. “This feature alone, however, does not distinguish subjects experiencing spontaneous [postprandial hypoglycemia] from those who do not. In contrast, the occurrence of [postprandial hypoglycemia] is consistently predicted by a better metabolic phenotype, including higher insulin sensitivity and beta-cell glucose sensitivity before surgery; a lower BMI before the intervention and a higher glucose peak on the OGTT after the operation may make additional contributions. A strong [postprandial hypoglycemia] provocative test, such as the OGTT, as part of the preoperative assessment may have clinical utility in the prevention of post-bariatric hypoglycemia.” – by Amber Cox
Disclosure: The researchers report no relevant financial disclosures.
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