Obesity Surgery

, Volume 22, Issue 4, pp 582–586

Acarbose Improves Hypoglycaemia Following Gastric Bypass Surgery Without Increasing Glucagon-Like Peptide 1 Levels

  • Juan Patricio Valderas
  • Jessica Ahuad
  • Lorena Rubio
  • Manuel Escalona
  • Felipe Pollak
  • Alberto Maiz
Clinical Research

Abstract

Background

Postprandial hypoglycaemia is a severe complication of Roux-en-Y gastric bypass (RYGBP). Acarbose, an α-glucosidase inhibitor (AGI), is employed in its treatment. Several studies have shown that AGIs increase the postprandial levels of glucagon-like peptide 1 (GLP-1). However, an excessive level of GLP-1 is one of the factors involved in the physiopathology of this condition. We analysed the effect of acarbose oral administration in eight RYBGP patients with clinically significant hypoglycaemia or dumping syndrome.

Methods

Glucose, insulin and GLP-1 plasma levels in fasting and after ingestion of a standard meal (Ensure Plus®; 13 g protein, 50 g carbohydrate, 11 g fat) were measured. The test was repeated the following week with the oral administration of 100 mg of acarbose 15 min prior to the meal.

Results

Five patients developed asymptomatic hypoglycaemia during the test (glucose level <50 mg/dl) with inappropriately high insulin levels and exaggerated GLP-1 response. Acarbose ingestion avoided hypoglycaemia in all of the patients and increased the lowest plasma glucose level (46.4 ± 4.8 vs. 59.0 ± 2.6 mg/dl, p < 0.01). Acarbose ingestion decreased the area under the curve for serum insulin and GLP-1 levels at 15 min after the meal.

Conclusions

Acarbose avoided postprandial hypoglycaemia following RYGBP by decreasing the hyperinsulinemic response. This was associated with a decrease in early GLP-1 secretion, in contrast to that observed in non-surgical subjects. This finding could be explained by the reduction of glucose load in the jejunum produced by the α-glucosidase inhibition, which is the main stimulus for GLP-1 secretion.

Keywords

Glucagon-like peptide 1 Acarbose Hypoglycaemia Gastric bypass 

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Copyright information

© Springer Science + Business Media, LLC 2011

Authors and Affiliations

  • Juan Patricio Valderas
    • 1
  • Jessica Ahuad
    • 1
  • Lorena Rubio
    • 1
  • Manuel Escalona
    • 1
  • Felipe Pollak
    • 1
  • Alberto Maiz
    • 1
  1. 1.Department of Nutrition, Diabetes and Metabolism, School of MedicinePontificia Universidad Catolica de ChileSantiagoChile

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