Impact of Postprandial Hypoglycemia on Weight Loss After Bariatric Surgery
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ORIGINAL CONTRIBUTIONS
Impact of Postprandial Hypoglycemia on Weight Loss After Bariatric Surgery Eleni Rebelos 1 & Diego Moriconi 1 & Marco Scalese 2 & Francesca Denoth 2 & Sabrina Molinaro 2 & Valeria Siciliano 2 & Marco Anselmino 3 & Stefano Taddei 1 & Ele Ferrannini 2 & Monica Nannipieri 1
# Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Introduction Postprandial hypoglycemia (PPHG) is a well-known complication after bariatric surgery (BS). However, it is not known whether PPHG affects weight loss after BS. Aims To assess the impact of PPHG on weight loss after BS in subjects without and with type 2 diabetes mellitus (T2D). Methods Data from 338 subjects who had undergone gastric bypass (RYGB) or sleeve gastrectomy (LSG) and were followed up for at least 2 years were analyzed. At each follow-up visit, the patient’s anthropometric and biochemical characteristics were recorded and the Edinburgh Questionnaire was performed to evaluate the presence of PPHG symptoms. Results Before surgery: younger age and lower BMI predicted PPHG after BS (p = 0.02 and p = 0.0008, respectively). Also, the baseline OGTT indicated that subjects who developed PPHG had an earlier glucose peak and more often had low glucose levels at 2 h compared with the no-PPHG group (p = 0.03 and p = 0.004, respectively). After surgery: Mild-to-moderate PPHG occurred equally after RYGB and LSG (38% vs 25%, p = ns when accounting for confounders), and in T2D who achieved remission and those who did not (29.5% vs 28.6%, ns). At the 2-year follow-up, occurrence of PPHG was independently associated with smaller weight loss (p = 0.0006). Conclusions Mild-to-moderate PPHG is a frequent complication after bariatric surgery and results in smaller weight loss after 2 years. Age, baseline BMI, and an earlier glucose peak during OGTT predict PPHG after bariatric surgery. Keywords Postprandial hypoglycemia . Bariatric surgery . RYGB . Sleeve gastrectomy . Weight loss
Abbreviations ALT Alanine aminotransferase AST Aspartate aminotransferase BMI Body mass index CHO Carbohydrates CGM Continuous glucose monitoring Electronic supplementary material The online version of this article (https://doi.org/10.1007/s11695-020-04465-9) contains supplementary material, which is available to authorized users. * Eleni Rebelos [email protected] 1
Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
2
CNR Institute of Clinical Physiology, Pisa, Italy
3
Unit of Bariatric Surgery, AOUP, Pisa, Italy
γGT eGFR EPIC HbA1c HDL IQR LD LDL LSG MMT NGT OGTT PPHG PTH RYGB T2D BS
Gamma-glutamyltransferase Estimated glomerular filtration rate European Prospective Investigation into Cancer and Nutrition Glycosylated hemoglobin High-density lipoproteins Interquartile range Late dumping syndrome Low-density lipoproteins Laparoscopic sleeve gastrectomy Mixed meal test Normal glucose tolerance Oral glucose tolerance test Postprandial hypoglycemia Parathyroid hormone Roux-en-Y gastric bypass Type 2 diabetes mellitus Bariatric su
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