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Bienvenot R, Sirveaux MA, Nguyen-Thi PL, Brunaud L, Quilliot D. Symptomatic Hypoglycemia After Gastric Bypass: Incidence and Predictive Factors in a Cohort of 1,138 Consecutive Patients. Obesity (Silver Spring) 2021; 29:681-688. [PMID: 33608995 DOI: 10.1002/oby.23118] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 12/14/2020] [Accepted: 12/21/2020] [Indexed: 12/20/2022]
Abstract
OBJECTIVE After Roux-en-Y gastric bypass (RYGB), postprandial hyperinsulinemic hypoglycemia (PPHH) is particularly critical because of the risk of trauma. The aim of this study was to assess the incidence and identify risk factors for symptomatic PPHH. METHODS Patients with RYGB were classified into moderate PPHH (MH) or severe hypoglycemia (SH), which is defined as patients with neuroglycopenic symptoms. Logistic multivariate linear regressions were performed to identify predictive factors for symptomatic PPHH and more specifically for SH with neuroglycopenic symptoms. Patients with diabetes and those with a follow-up shorter than 2 years were excluded. RESULTS Among the 1,138 patients, 44.2% had at least one episode of hypoglycemia with a mean delay of 25.5 (21.3) months, 32.6% had MH, and 11.6% had SH. The annual incidence rate of SH was 2.5% the first year, 3.7% the second year, and 1.5% the third year. Independent predictive factors for higher risk of SH were: younger age (odds ratio [OR] = 1.01; 95% CI: 1.05-16.69; P = 0.0007), lower BMI after RYGB (OR = 1.61; 95% CI: 1.17-2.22; P = 0.0035), and maximal weight loss (OR = 1.04; 95% CI = 1.39-1.23; P = 0.0106), whereas higher preoperative BMI was protective (OR = 0.78; 95% CI: 0.64-0.95; P = 0.0112). CONCLUSIONS This observational cohort study showed that the incidence of severe PPHH with neuroglycopenic symptoms after RYGB was higher than expected.
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Affiliation(s)
- Rébecca Bienvenot
- Department of Endocrinology, Diabetology and Nutrition, University of Lorraine, CHRU Nancy, Brabois Hospital, Nancy, France
| | - Marie-Aude Sirveaux
- Department of Visceral, Metabolic and Cancer Surgery (CVMC), Multidisciplinary Unit for Obesity Surgery (UMCO), University of Lorraine, CHRU Nancy, Brabois Hospital, Vandoeuvre-lès-Nancy, France
| | - Phi-Linh Nguyen-Thi
- Medical Evaluation Department, Department of Clinical Research Support PARC, University of Lorraine, CHU Nancy, Nancy, France
| | - Laurent Brunaud
- Department of Visceral, Metabolic and Cancer Surgery (CVMC), Multidisciplinary Unit for Obesity Surgery (UMCO), University of Lorraine, CHRU Nancy, Brabois Hospital, Vandoeuvre-lès-Nancy, France
- INSERM U1256, Nutrition, Genetics, Environmental Risks, Faculty of Medicine, University of Lorraine, Nancy, France
| | - Didier Quilliot
- Department of Endocrinology, Diabetology and Nutrition, University of Lorraine, CHRU Nancy, Brabois Hospital, Nancy, France
- Department of Visceral, Metabolic and Cancer Surgery (CVMC), Multidisciplinary Unit for Obesity Surgery (UMCO), University of Lorraine, CHRU Nancy, Brabois Hospital, Vandoeuvre-lès-Nancy, France
- INSERM U1256, Nutrition, Genetics, Environmental Risks, Faculty of Medicine, University of Lorraine, Nancy, France
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Preoperative Prediction of Postprandial Glycemia After Roux-en-Y Gastric Bypass. Ann Surg 2017; 267:e84-e85. [PMID: 28288071 DOI: 10.1097/sla.0000000000002203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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