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Diminished Counterregulatory Responses to Meal-Induced Hypoglycemia 4 Years After RYGB

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Abstract

Purpose

Post-bariatric hypoglycemia is a complication of bariatric surgery, especially Roux-en-Y gastric bypass (RYGB). The counterregulatory hormonal and sympathetic neural responses were measured during a previously reported meal test in which 48% had an almost asymptomatic hypoglycemic event.

Materials and Methods

Forty-four randomly selected patients 4 years after RYGB. A liquid meal test (MMT) after overnight fasting. Based on the glucose nadir during the MMT, patients were divided in a hypo group (glucose < 3.3 mmol/L) and a non-hypo group (glucose ≥ 3.3 mmol/L). Cortisol, epinephrine, norepinephrine, blood pressure, and heart rate were measured up to 180 min after ingestion of the meal. Incremental areas under the curve (iAUC), peak, and delta hormone responses after the glucose nadir were calculated. Parameters were compared between the hypo and non-hypo groups.

Results

A total of 21/44 (48%) had an almost asymptomatic hypoglycemic event. Cortisol and epinephrine responses in the hypo group were not increased compared to the non-hypo group, and there were no signs of increased sympathetic nerve activity. Peak and delta cortisol were lower in the hypo compared to the non-hypo group. Norepinephrine was higher in the hypo group especially in the time frame 60–120 and 120–180 min after start of the meal.

Conclusion

No increase in epinephrine and a lower cortisol response to hypoglycemia were observed compared to normoglycemia during a meal test in patients after RYGB. Norepinephrine levels were higher in the hypo group. These findings may suggest that possible recurrent hypoglycemia after RYGB results in blunting of counterregulatory responses indicative of hypoglycemia-induced autonomic failure.

Clin Trial Register ID

ISRCTN 11738149.

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Data Availability

All data used in the “Results” section of this manuscript can be made available on request to the corresponding author.

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Acknowledgments

We thank Jan Bruggink for technical assistance in the measurements of the catecholamines.

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Authors and Affiliations

  1. Center for Obesity North-Netherlands (CON), Medical Center Leeuwarden, H. Dunantweg 2, 8934 AD, Leeuwarden, The Netherlands

    Loek J. M. de Heide, Merel van den Broek & Marloes Emous

  2. GELIFES-Neurobiology, Department of Behavioral Neuroscience, University of Groningen, Groningen, The Netherlands

    Gertjan van Dijk

  3. Department of Endocrinology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands

    André P. van Beek

Authors
  1. Loek J. M. de Heide
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  2. Merel van den Broek
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  3. Gertjan van Dijk
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  4. Marloes Emous
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  5. André P. van Beek
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Corresponding author

Correspondence to Loek J. M. de Heide.

Ethics declarations

The study was conducted in compliance with the Declaration of Helsinki. The study protocol was approved by the Medical Ethical Review Board Leeuwarden. Written informed consent has been obtained from each patient.

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The authors declare that they have no conflict of interest.

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de Heide, L.J.M., van den Broek, M., van Dijk, G. et al. Diminished Counterregulatory Responses to Meal-Induced Hypoglycemia 4 Years After RYGB. OBES SURG 31, 597–602 (2021). https://doi.org/10.1007/s11695-020-05035-9

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  • DOI: https://doi.org/10.1007/s11695-020-05035-9

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