Esmeralda Capristo1, Simona Panunzi2, Andrea De Gaetano2, Valerio Spuntarelli1, Rocco Bellantone3, Piero Giustacchini3, Andreas L Birkenfeld4,5,6, Stephanie Amiel5, Stefan R Bornstein4,5,6, Marco Raffaelli3, Geltrude Mingrone1,5. 1. Department of Internal Medicine, Catholic University, Rome, Italy. 2. CNR-Institute of Systems Analysis and Computer Science, BioMatLab, Rome, Italy. 3. Department of General Surgery, Catholic University, Rome, Italy. 4. Department of Medicine III, Universitätsklinikum Carl Gustav Carus an der Technischen Universität Dresden, Dresden, Germany. 5. Diabetes and Nutritional Sciences, King's College London, London, United Kingdom. 6. Paul Langerhans Institute Dresden of the Helmholtz Center Munich at University Hospital Dresden, a member of the German Center for Diabetes Research, Dresden, Germany.
Abstract
Context: We compared the incidence of hypoglycemia after Roux-en-Y gastric bypass (RYGB) vs sleeve gastrectomy (SG). Design, Setting, and Main Outcome Measures: Randomized, open-label trial conducted at the outpatient obesity clinic in a university hospital in Rome, Italy. The primary aim was the incidence of reactive hypoglycemia (<3.1 mmol/L after 75-g oral glucose load) at 1 year after surgery. Secondary aims were hypoglycemia under everyday life conditions, insulin sensitivity, insulin secretion, and lipid profile. Results: Of 175 eligible patients, 120 were randomized 1:1 toRYGB or SG; 117 (93%) completed the 12-month follow-up. Reactive hypoglycemia was detected in 14% and 29% of SG and RYGB patients (P = 0.079), respectively, with the effect of treatment in multivariate analysis significant at P = 0.018. Daily hypoglycemic episodes during continuous glucose monitoring did not differ between groups (P = 0.75). Four of 59 RYGB subjects (6.8%) had 1 to 3 hospitalizations for symptomatic hypoglycemia vs 0 in SG. The static β-cell glucose sensitivity index increased after both treatments (P < 0.001), but the dynamic β-cell glucose sensitivity index increased significantly in SG (P = 0.008) and decreased in RYGB (P = 0.004 for time × treatment interaction). Whole-body insulin sensitivity increased about 10-fold in both groups. Conclusions: We show that reactive hypoglycemia is no less common after SG and is not a safer option than RYGB, but RYGB is associated with more severe hypoglycemic episodes. This is likely due to the lack of improvement of β-cell sensitivity to changes in circulating glucose after RYGB, which determines an inappropriately high insulin secretion.
RCT Entities:
Context: We compared the incidence of hypoglycemia after Roux-en-Y gastric bypass (RYGB) vs sleeve gastrectomy (SG). Design, Setting, and Main Outcome Measures: Randomized, open-label trial conducted at the outpatientobesity clinic in a university hospital in Rome, Italy. The primary aim was the incidence of reactive hypoglycemia (<3.1 mmol/L after 75-g oral glucose load) at 1 year after surgery. Secondary aims were hypoglycemia under everyday life conditions, insulin sensitivity, insulin secretion, and lipid profile. Results: Of 175 eligible patients, 120 were randomized 1:1 to RYGB or SG; 117 (93%) completed the 12-month follow-up. Reactive hypoglycemia was detected in 14% and 29% of SG and RYGB patients (P = 0.079), respectively, with the effect of treatment in multivariate analysis significant at P = 0.018. Daily hypoglycemic episodes during continuous glucose monitoring did not differ between groups (P = 0.75). Four of 59 RYGB subjects (6.8%) had 1 to 3 hospitalizations for symptomatic hypoglycemia vs 0 in SG. The static β-cell glucose sensitivity index increased after both treatments (P < 0.001), but the dynamic β-cell glucose sensitivity index increased significantly in SG (P = 0.008) and decreased in RYGB (P = 0.004 for time × treatment interaction). Whole-body insulin sensitivity increased about 10-fold in both groups. Conclusions: We show that reactive hypoglycemia is no less common after SG and is not a safer option than RYGB, but RYGB is associated with more severe hypoglycemic episodes. This is likely due to the lack of improvement of β-cell sensitivity to changes in circulating glucose after RYGB, which determines an inappropriately high insulin secretion.
Authors: Stephan C Bischoff; Rocco Barazzoni; Luca Busetto; Marjo Campmans-Kuijpers; Vincenzo Cardinale; Irit Chermesh; Ahad Eshraghian; Haluk Tarik Kani; Wafaa Khannoussi; Laurence Lacaze; Miguel Léon-Sanz; Juan M Mendive; Michael W Müller; Johann Ockenga; Frank Tacke; Anders Thorell; Darija Vranesic Bender; Arved Weimann; Cristina Cuerda Journal: United European Gastroenterol J Date: 2022-08-12 Impact factor: 6.866
Authors: Christopher M Mulla; Stamatina Zavitsanou; Alejandro Jose Laguna Sanz; David Pober; Lauren Richardson; Pamela Walcott; Ipsa Arora; Brett Newswanger; Martin J Cummins; Steve J Prestrelski; Francis J Doyle; Eyal Dassau; Mary Elizabeth Patti Journal: J Clin Endocrinol Metab Date: 2020-04-01 Impact factor: 5.958