UK: Obese patients with diabetes undergoing gastric bypass surgery are at increased risk of developing low blood sugar (hypoglycemia) post-surgery, suggests a recent study in the journal Diabetes Care. Postbariatric hypoglycemia could be due to a combination of increased glycemic variability (GV), increased GLP-1 response, and reduced levels of mean glucose.
Roux-en-Y gastric bypass (RYGB) is an established treatment for obesity and type 2 diabetes. Ibiyemi Ilesanmi, Imperial College London, London, U.K, and colleagues aimed to establish the effect of RYGB on GV and hypoglycemia in this prospective observational study of 10 patients with prediabetes or type 2 diabetes and obesity.
The patients were studied before RYGB and 1 month, 1 year, and 2 years postsurgery with continuous glucose measurement (CGM). A mixed-meal test (MMT) was conducted at Pre, 1 month, and 1 year.
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Key findings of the study include:
After RYGB, mean CGM decreased (at 1 month, 1 year, and 2 years), and GV increased (at 1 year and 2 years).
Five of the 10 participants had a percent time in range (%TIR) <3.0 mmol/L (54 mg/dL) greater than the international consensus target of 1% at 1 or 2 years.
Peak glucagon-like peptide-1 (GLP-1) and glucagon area under the curve during MMT were positively and negatively associated, respectively, with contemporaneous %TIR <3.0 mmol/L.
"Our findings demonstrate that patients undergoing RYGB are at risk for development of postbariatric hypoglycemia due to a combination of reduced mean glucose level, increased GV, and increased GLP-1 response," concluded the authors.
Also Read: CGM improves blood sugar control, prevents hypoglycemia in T1D: Study
"Roux-en-Y Gastric Bypass Increases Glycemic Variability and Time in Hypoglycemia in Patients With Obesity and Prediabetes or Type 2 Diabetes: A Prospective Cohort Study, is published in the journal Diabetes Care.
DOI: https://care.diabetesjournals.org/content/early/2020/12/14/dc20-1609