Hypoglycemia in everyday life after gastric bypass and duodenal switch
Hypoglycemia in everyday life after gastric bypass and duodenal switch
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DOI：
10.1530/eje-14-0821
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发表时间：
2015-07-01
影响因子：
5.8
通讯作者：
Karlsson, F. Anders
中科院分区：
文献类型：
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作者：
Abrahamsson, Niclas;Engstrom, Britt Eden;Karlsson, F. Anders
设计：病态肥胖的胃绕道术（GBP）和十二指肠转术（DS）伴随着显着的代谢改善，特别是在血糖控制方面。近年来，越来越多的 GBP 患者出现严重的晚期餐后低血糖。 DS 患者的数据很少。我们招募了三组受试者； 15 GBP、15 DS 和 15 个非手术超重对照，以检查日常生活中低血糖发生的程度。方法：在 3 天的正常活动期间使用连续血糖监测 (CGM)。血糖变异性通过血糖偏移的平均幅度和连续的总体净血糖作用来测量。抽取空腹血样，患者在整个研究过程中保留食物和症状日志。结果：GBP 组表现出高度可变的 CGM 曲线，2.9% 的时间花在低血糖上（< 3.3 mmol/l，或 60 mg/dl）。 DS 组的低血糖时间是前者的两倍 (5.9%)，并且 CGM 曲线几乎没有变化，并且 HbA1c 水平较低（29.3 vs 35.9 mmol/mol，P < 0.05）。在这 3 天内总共记录了 72 次低血糖发作，其中 70 次（97%）发生在餐后状态，GBP 和 DS 组中只有约五分之一的低血糖发作伴有症状。三天期间，对照组未出现低血糖。结论：两种类型的减肥手术都会引起明显但不同的葡萄糖平衡变化，并伴有频繁但主要未被注意到的低血糖发作。减重手术后低血糖不自觉的影响和机制值得阐明。
Design: Gastric bypass (GBP) and duodenal switch (DS) in morbid obesity are accompanied by marked metabolic improvements, particularly in glucose control. In recent years, episodes of severe late postprandial hypoglycemia have been increasingly described in GBP patients; data in DS patients are scarce. We recruited three groups of subjects; 15 GBP, 15 DS, and 15 non-operated overweight controls to examine to what extent hypoglycemia occurs in daily life.Methods: Continuous glucose monitoring (CGM) was used during 3 days of normal activity. The glycemic variability was measured by mean amplitude of glycemic excursion and continuous overall net glycemic action. Fasting blood samples were drawn, and the patients kept a food and symptom log throughout the study.Results: The GBP group displayed highly variable CGM curves, and 2.9% of their time was spent in hypoglycemia (< 3.3 mmol/l, or 60 mg/dl). The DS group had twice as much time in hypoglycemia (5.9%) and displayed CGM curves with little variation as well as lower HbA1c levels (29.3 vs 35.9 mmol/mol, P < 0.05). Out of a total of 72 hypoglycemic episodes registered over the 3-day period, 70 (97%) occurred in the postprandial state and only about one-fifth of the hypoglycemic episodes in the GBP and DS groups were accompanied by symptoms. No hypoglycemias were seen in controls during the 3-day period.Conclusion: Both types of bariatric surgery induce marked, but different, changes in glucose balance accompanied by frequent, but mainly unnoticed, hypoglycemic episodes. The impact and mechanism of hypoglycemic unawareness after weight-reduction surgery deserves to be clarified.