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Features of oral glucose tolerance tests in patients after Roux‐en‐Y gastric bypass with and without hypoglycaemia symptoms in daily life: It's all about speed
Author(s) -
Mariën Ilke,
De Block Christophe,
Verrijken An,
Van Dessel Kristof,
Peiffer Frida,
Verhaegen Ann,
Hubens Guy,
Van Gaal Luc,
Dirinck Eveline
Publication year - 2020
Publication title -
diabetes, obesity and metabolism
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.445
H-Index - 128
eISSN - 1463-1326
pISSN - 1462-8902
DOI - 10.1111/dom.14130
Subject(s) - asymptomatic , medicine , gastric bypass , gastroenterology , insulin , group b , glucose tolerance test , insulin resistance , endocrinology , surgery , weight loss , obesity
Objective To evaluate the glucose and insulin profiles during an oral glucose tolerance test (OGTT) after Roux‐en‐Y gastric bypass (RYGB) in symptomatic and asymptomatic patients. Research design and methods This retrospective study consisted of two groups that had undergone RYGB. The symptomatic (S) group (n = 27) had an OGTT at presentation, whereas the asymptomatic (A) group (n = 99) had an OGTT 1 year after RYGB. Each group was subdivided into two groups, namely, those with glycaemia <54 mg/dL (S1/A1) and those with glycaemia >54 mg/dL (S2/A2) during OGTT. Most of the patients underwent OGTT preoperatively. Results Preoperatively, the glucose and insulin levels, as well as the speed of increase and decrease, were similar in all groups. Postoperatively, the minimum glucose levels during the OGTT did not differ between the symptomatic and asymptomatic groups (55 ± 19 vs. 54 ± 17 mg/dL) or between the S1 and A1 subgroups (39 ± 7 vs. 43 ± 8 mg/dL). The peak glucose values were higher in the symptomatic versus the asymptomatic group (236 ± 52 vs. 189 ± 43 mg/dL; P <0.05) and in the S1 and S2 versus the A1 and A2 subgroups. The speed of glucose increase and decline was significantly higher in the symptomatic group versus the asymptomatic group, with the speed of glucose decline being the highest in the S1 subgroup. Conclusion Assessing hypoglycaemia after a gastric bypass remains challenging. Our study suggests that the main difference in glucose dynamics between symptomatic and asymptomatic patients might be the speed of glucose and insulin increase and decline during OGTT rather than the absolute values obtained.