Ronald Kefurt1, Felix B Langer1, Karin Schindler2, Soheila Shakeri-Leidenmühler1, Bernhard Ludvik2, Gerhard Prager3. 1. Department of Surgery, Division of General Surgery, Medical University of Vienna, Vienna, Austria. 2. Department of Internal Medicine 3, Medical University of Vienna, Vienna, Austria. 3. Department of Surgery, Division of General Surgery, Medical University of Vienna, Vienna, Austria. Electronic address: gerhard.prager@meduniwien.ac.at.
Abstract
BACKGROUND: Neuroglucopenic hypoglycemia might be an underestimated threat for roux-en-Y gastric bypass (RYGB) patients leading to fatigue, syncope, seizures or even accidental deaths. Different measurements can assess hypoglycemia such as a finger-stick glucometer, an Oral Glucose Tolerance Test, a Mixed Meal-Test (MMT) or, as introduced recently, continuous glucose monitoring (CGM). SETTING: University Hospital, Austria. METHODS: To assess the incidence of hypoglycemic episodes under real life conditions, 5-day CGM was performed in a series of 40 patients at a mean of 86 months after RYGB. The detection rates were compared to a mixed meal-test. RESULTS: CGM detected hypoglycemic episodes of <55 mg/dL or <3.05 mmol/L in 75% of the patients, while MMT indicated hypoglycemia in 29% of the patients. CGM also detected nocturnal hypoglycemic episodes in 15 (38%) of the patients. A mean of 3±1 hypoglycemic episodes per patient with a mean duration of 71±25 minutes were observed by CGM. CONCLUSIONS: Assessed under real life conditions by CGM, post-RYGB hypoglycemia was found more frequently than expected. CGM revealed hypoglycemic episodes in 75% of the patients while MMT had a lower detection rate. Thus, CGM may have a role for screening but also for the evaluation of dietary modifications, drug therapy or surgical intervention for hypoglycemia after RYGB.
BACKGROUND:Neuroglucopenic hypoglycemia might be an underestimated threat for roux-en-Y gastric bypass (RYGB) patients leading to fatigue, syncope, seizures or even accidental deaths. Different measurements can assess hypoglycemia such as a finger-stick glucometer, an Oral Glucose Tolerance Test, a Mixed Meal-Test (MMT) or, as introduced recently, continuous glucose monitoring (CGM). SETTING: University Hospital, Austria. METHODS: To assess the incidence of hypoglycemic episodes under real life conditions, 5-day CGM was performed in a series of 40 patients at a mean of 86 months after RYGB. The detection rates were compared to a mixed meal-test. RESULTS: CGM detected hypoglycemic episodes of <55 mg/dL or <3.05 mmol/L in 75% of the patients, while MMT indicated hypoglycemia in 29% of the patients. CGM also detected nocturnal hypoglycemic episodes in 15 (38%) of the patients. A mean of 3±1 hypoglycemic episodes per patient with a mean duration of 71±25 minutes were observed by CGM. CONCLUSIONS: Assessed under real life conditions by CGM, post-RYGB hypoglycemia was found more frequently than expected. CGM revealed hypoglycemic episodes in 75% of the patients while MMT had a lower detection rate. Thus, CGM may have a role for screening but also for the evaluation of dietary modifications, drug therapy or surgical intervention for hypoglycemia after RYGB.
Authors: Alejandro J Laguna Sanz; Christopher M Mulla; Kristen M Fowler; Emilie Cloutier; Allison B Goldfine; Brett Newswanger; Martin Cummins; Sunil Deshpande; Steven J Prestrelski; Poul Strange; Howard Zisser; Francis J Doyle; Eyal Dassau; Mary-Elizabeth Patti Journal: Diabetes Technol Ther Date: 2018-02 Impact factor: 6.118
Authors: Mary-Elizabeth Patti; Allison B Goldfine; Jiang Hu; Dag Hoem; Anders Molven; Jeffrey Goldsmith; Wayne H Schwesinger; Stefano La Rosa; Franco Folli; Rohit N Kulkarni Journal: Acta Diabetol Date: 2017-05-17 Impact factor: 4.280