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Incidence and Predictors of Hypoglycemia 1 Year After Laparoscopic Sleeve Gastrectomy

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Abstract

Introduction

Hypoglycemia is a known adverse event following gastric bypass. The incidence of hypoglycemia after laparoscopic sleeve gastrectomy (LSG) is still under investigation. The aim of our study was to verify the presence of oral glucose tolerance test (OGTT)-related hypoglycemia after LSG and to identify any baseline predictors of its occurrence.

Methods

We analyzed 197 consecutive non-diabetic morbid obese patients that underwent LSG. All patients were studied before and 12 months after LSG. Evaluation included anthropometric parameters, 3-h OGTT for blood glucose (BG), insulin and c-peptide, lipid profile, interleukin-6 (IL-6), tumor necrosis factor alpha (TNF-α), highly sensitive C-reactive protein (hsCRP), and leptin. Hypoglycemia was defined as BG ≤ 2.7 mmol/l.

Results

After surgery, 180 patients completed the OGTT. Eleven patients did not complete the test for gastric intolerance, and in six patients, the test was stopped earlier for the onset of severe symptomatic hypoglycemia. Of the patients, 61/186 (32.8%) had at least one OGTT-related hypoglycemia. The highest frequency of hypoglycemic events occurred 150′ after glucose load (20.2%). At baseline, patients with hypoglycemic events after surgery (Hypo) were younger (40 ± 11 vs 46 ± 10 years; p < 0.001), less obese (BMI 46 ± 5.7 vs 48.4 ± 7.9 kg/m2; p < 0.05), and had a worse lipid profile as compared to patients without hypoglycemic events (N-Hypo). Moreover, after LSG, Hypo patients compared with N-Hypo presented a higher weight loss (%EBMIL 80 ± 20 vs 62 ± 21%; p < 0.001). Low age, low fasting glucose, and high triglyceride levels before LSG were independent predictors of hypoglycemia development after surgery (r 2 = 0.131).

Conclusion

These findings confirm the high incidence of post-prandial hypoglycemia 1 year after LSG. Hypoglycemia is more frequent in younger patients with lower fasting glucose and higher triglyceride levels before surgery.

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References

  1. Angrisani L, Santonicola A, Iovino P, et al. Bariatric surgery worldwide 2013. Obes Surg. 2015;25(10):1822–32.

    Article  CAS  PubMed  Google Scholar 

  2. Colquitt JL, Pickett K, Loveman E, et al. Cochrane. Surgery for weight loss in adults. Cochrane Database Syst Rev. 2014;8(8):CD003641.

    Google Scholar 

  3. Fridman A, Moon R, Cozacov Y, et al. Procedure-related morbidity in bariatric surgery: a retrospective short- and mid-term follow-up of a single institution of the American College of Surgeons bariatric surgery centers of excellence. J Am Coll Surg. 2013;217(4):614–20.

    Article  PubMed  Google Scholar 

  4. Service GJ, Thompson GB, Service FJ, et al. Hyperinsulinemic hypoglycemia with nesidioblastosis after gastric-bypass surgery. N Engl J Med. 2005;353:249–54.

    Article  CAS  PubMed  Google Scholar 

  5. Kim SH, Liu TC, Abbasi F, et al. Plasma glucose and insulin regulation is abnormal following gastric bypass surgery with or without neuroglycopenia. Obes Surg. 2009;19:1550–6.

    Article  PubMed  Google Scholar 

  6. Goldfine AB, Mun EC, Devine E, et al. Patients with neuroglycopenia after gastric bypass surgery have exaggerated incretin and insulin secretory responses to a mixed meal. J Clin Endocrinol Metab. 2007;92:4678–85.

    Article  CAS  PubMed  Google Scholar 

  7. Mala T. Postprandial hyperinsulinemic hypoglycemia after gastric bypass surgical treatment. Surg Obes Relat Dis. 2014;10(6):1220–5.

    Article  PubMed  Google Scholar 

  8. Foster-Schubert KE. Hypoglycemia complicating bariatric surgery: incidence and mechanisms. Curr Opin Endocrinol Diabetes Obes. 2011;18(2):129–33.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Bojsen-Møller KN, Dirksen C, Jørgensen NB, et al. Early enhancements of hepatic and later of peripheral insulin sensitivity combined with increased postprandial insulin secretion contribute to improved glycemic control after Rouxen-Y gastric bypass. Diabetes. 2014;63:1725–37.

    Article  PubMed  Google Scholar 

  10. Melissas J, Koukouraki S, Askoxylakis J, et al. Sleeve gastrectomy: a restrictive procedure? Obes Surg. 2007;17:57–62.

    Article  PubMed  Google Scholar 

  11. Baumann T, Kuesters S, Grueneberger J, et al. Time-resolved MRI after ingestion of liquids reveals motility changes after laparoscopic sleeve gastrectomy—preliminary results. Obes Surg. 2011;21:95–101.

    Article  PubMed  Google Scholar 

  12. Dimitriadis E, Daskalakis M, Kampa M, et al. Alterations in gut hormones after laparoscopic sleeve gastrectomy: a prospective clinical and laboratory investigational study. Ann Surg. 2013;257(4):647–54.

    Article  PubMed  Google Scholar 

  13. Natoudi M, Panousopoulos SG, Memos N, et al. Laparoscopic sleeve gastrectomy for morbid obesity and glucose metabolism: a new perspective. Surg Endosc. 2014;28(3):1023–33.

    Article  Google Scholar 

  14. Papamargaritis D, Koukoulis G, Sioka E, et al. Dumping symptoms and incidence of hypoglycaemia after provocation test at 6 and 12 months after laparoscopic sleeve gastrectomy. Obes Surg. 2012;22(10):1600–6.

    Article  PubMed  Google Scholar 

  15. National Institutes of Health Consensus Development Conference draft Statement. Gastrointestinal surgery for severe obesity. Obes Surg. 1991;1:257–66.

    Article  Google Scholar 

  16. Bernante P, Foletto M, Busetto L, et al. Feasibility of laparoscopic sleeve gastrectomy as a revision procedure for prior laparoscopic gastric banding. Obes Surg. 2006;16(10):1327–30.

    Article  PubMed  Google Scholar 

  17. America Diabetes Association. Standards of medical care in diabetes—2016. Diabetes Care. 2016;39(suppl 1):S1–S106.

    Google Scholar 

  18. Bonora E, Targher G, Alberiche M, et al. Homeostasis model assessment closely mirrors the glucose clamp technique in the assessment of insulin sensitivity: studies in subjects with various degrees of glucose tolerance and insulin sensitivity. Diabetes Care. 2000;23:57–63.

    Article  CAS  PubMed  Google Scholar 

  19. Pigeyre M, Vaurs C, Raverdy V, et al. Increased risk of OGTT-induced hypoglycemia after gastric bypass in severely obese patients with normal glucose tolerance. Surg Obes Relat Dis. 2015;11(3):573–7.

    Article  PubMed  Google Scholar 

  20. Rariy CM, Rometo D, Korytkowski M. Post-gastric bypass hypoglycemia. Curr Diab Rep. 2016;16:19.

    Article  PubMed  Google Scholar 

  21. Hammer HF. Medical complications of bariatric surgery: focus on malabsorption and dumping syndrome. Dig Dis. 2012;30(2):182–6.

    Article  PubMed  Google Scholar 

  22. Papamargaritis D, Zacharoulis D, Sioka E, et al. Differences in anthropometric and metabolic parameters between subjects with hypoglycaemia and subjects with euglycaemia after an oral glucose tolerance test six months after laparoscopic sleeve gastrectomy. Obes Surg. 2016;26(11):2747–55.

    Article  PubMed  Google Scholar 

  23. Adams TD, Gress RE, Smith SC, et al. Long-term mortality after gastric bypass surgery. N Engl J Med. 2007;357(8):753–61.

    Article  CAS  PubMed  Google Scholar 

  24. Mitchell JE, Crosby R, de Zwaan M, et al. Possible risk factors for increased suicide following bariatric surgery. Obesity (Silver Spring). 2013;21(4):665–72.

    Article  Google Scholar 

  25. Ellingsgaard H, Hauselmann I, Schuler B, et al. Interleukin-6 enhances insulin secretion by increasing glucagon-like peptide-1 secretion from L cells and alpha cells. Nat Med. 2011;17:1481–9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  26. Kahles F, Meyer C, Möllmann J, et al. GLP-1 secretion is increased by inflammatory stimuli in an IL-6-dependent manner, leading to hyperinsulinemia and blood glucose lowering. Diabetes. 2014;63:3221–9.

    Article  CAS  PubMed  Google Scholar 

  27. Hotamisligil GS, Shargill NS, Spiegelman BM. Adipose expression of tumor necrosis factor alpha: direct role in obesity-linked insulin resistance. Sci. 1993;259:87–91.

    Article  CAS  Google Scholar 

  28. Hotamisligil GS. The role of TNFalpha and TNF-receptors in obesity and insulin resistance. J Intern Med. 1999;245:624–5.

    Article  Google Scholar 

  29. Nannipieri M, Belligoli A, Guarino D, et al. Risk factors for spontaneously self-reported postprandial hypoglycemia after bariatric surgery. J Clin Endocrinol Metab. 2016;101(10):3600–7.

    Article  CAS  PubMed  Google Scholar 

  30. Lee CJ, Clark JM, Schweitzer M, et al. Prevalence of and risk factors for hypoglycemic symptoms after gastric bypass and sleeve gastrectomy. Obesity. 2015;23:1079–84.

    Article  PubMed  PubMed Central  Google Scholar 

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Authors and Affiliations

  1. Center for the Study and the Integrated Management of Obesity, University Hospital of Padova, Padova, Italy

    Anna Belligoli, Marta Sanna, Roberto Serra, Roberto Fabris, Chiara Dal Pra’, Scilla Conci, Paola Fioretto, Luca Prevedello, Mirto Foletto, Roberto Vettor & Luca Busetto

  2. Clinica Medica 3, Azienda Ospedaliera di Padova, Via Giustiniani 2, 35100, Padova, Italy

    Anna Belligoli

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  1. Anna Belligoli
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  2. Marta Sanna
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  4. Roberto Fabris
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Contributions

Authors’ initials: AB, MS, RS, RF, CDP, SC, PF, LP, MF, RV, and LB.

AB: Study design, data analysis, and writing up of the first draft of the paper.

MS, RS, RF, CDP, SC, and PF: Patient’s recruitment and data collection.

LP and MF: Patient’s recruitment and bariatric procedures.

RV: Study design and review/edit the manuscript.

LB: Study design, data analysis, writing up of the first draft of the paper, and review/edit the manuscript.

Corresponding author

Correspondence to Anna Belligoli.

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Funding

None.

Conflict of Interest

Luca Busetto reports receiving personal fees as scientific consultant from Novo Nordisk and Intrapace. None of other authors report conflict of interest.

Ethical Approval

The study was approved by the Research Ethic Committee of the Padua University Hospital (protocol number 2892).

Informed Consent

Written informed consent was obtained for each individual participant to the study.

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Belligoli, A., Sanna, M., Serra, R. et al. Incidence and Predictors of Hypoglycemia 1 Year After Laparoscopic Sleeve Gastrectomy. OBES SURG 27, 3179–3186 (2017). https://doi.org/10.1007/s11695-017-2742-2

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  • DOI: https://doi.org/10.1007/s11695-017-2742-2

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