ECE2019 Poster Presentations Diabetes, Obesity and Metabolism 3 (112 abstracts)
Prevalence of postprandial hyperinsulinemic hypoglycaemia in a random population after primary Roux-en-Y gastric bypass during a mixed meal tolerance test
Marloes Emous 1, , Ragnhild Wijma 1 , Merel van den Broek 2 , Loek de Heide 2 , Gertjan van Dijk 3 , Albert Wolthuis 4 , Erik Totté 2 , Anke Laskewitz 4 , Bruce Wolffenbuttel 5 & André van Beek 2,
1Department of Bariatric and Metabolic Surgery, Medical Center Leeuwarden, Leeuwarden, Netherlands; 2Centre for Obesity Netherlands (CON), Medical Center Leeuwarden, Leeuwarden, Netherlands; 3GELIFES-Neurobiology, Department of Behavioral Neuroscience, University of Groningen, Groningen, Netherlands; 4Certe Laboratories, Medical Center Leeuwarden, Leeuwarden, Netherlands; 5Department of Endocrinology, University of Groningen, University Medical Center Groningen, Groningen, Netherlands.
Context: Roux-en-Y Gastric bypass (RYGB) is an effective way to induce sustainable weight loss. This operation can be complicated by late dumping, also known as postgastric bypass hyperinsulinemic hypoglycemia. Much is still unknown on its prevalence and its pathophysiology.
Objective: To study the prevalence and the main driving mechanisms behind the occurrence of hypoglycemia after a mixed meal tolerance test (MMTT) in patients with primary RYGB. Design, setting and patients: This is a cross-sectional study of patients at mid-term after primary RYGB and performed in a large peripheral hospital. From a total population of 550 patients, a random sample of 44 patients completed the total test procedures. A standardized mixed meal (Ensure Plus) was used as hypoglycemia inducing stimulus. Blood samples were collected at baseline, every 10 minutes during the first half hour and every 30 minutes until 210 minutes after the start. Symptoms were assessed by questionnaires. Main outcome measures: Hypoglycemia defined as a blood glucose below 3.3 mmol/L (60 mg/dL).
Results: The prevalence of postprandial hypoglycemia in this population was 48%. Hypoglycemia developed mainly between 60 and 120 minutes after the meal and was asymptomatic in all patients. Development of hypoglycemia was more frequent in patients with lower weight at surgery (P=0.045), with higher weight loss after surgery (P=0.011), and with higher insulin sensitivity calculated by Homeostasis Model Assessment indexes (HOMA2-IR P=0.014) and enhanced beta cell function (insulinogenic index at 20 minutes P=0.001).
Conclusion: In a random population mid-term after primary gastric bypass surgery an asymptomatic hypoglycemia event was inducible by a test meal in nearly half of the patients.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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