Postprandial hyperglycemia after a gastrectomy and the prediabetic state: a comparison between a distal and total gastrectomy.
OBJECTIVE
Postprandial hyperglycemia is recognized as an important risk factor for developing type 2 diabetes; it is also common in patients after a gastrectomy and is likely to become exacerbated after a total gastrectomy rather than after a distal gastrectomy. In this study, we investigated the glucose and insulin responses after oral glucose tolerance test (OGTT), and compared the incidence of postchallenge hyperglycemia after OGTT in patients after a distal and total gastrectomy.


METHODS
Forty-six patients, including 18 patients after a distal gastrectomy and 28 after a total gastrectomy, underwent a 75-g OGTT, and the plasma concentrations of glucose and insulin were measured after OGTT.


RESULTS
Glucose peaked at 30 min in the distal gastrectomy patients and 60 min in the total gastrectomy patients, and there were significant differences in the 1-h plasma glucose (PG) and 1.5-h PG levels between the distal and total gastrectomy patients. Insulin peaked at 60 min in both the distal and total gastrectomy patients, and there were significant differences in insulin levels at 60 min between the distal and total gastrectomy patients. The incidence of postchallenge hyperglycemia in the patients after a total gastrectomy (57.1%) was higher than in those after distal gastrectomy (27.8%). Moreover, significant positive correlations were found between 1-h PG and hemoglobin antigen HbA1c after a total gastrectomy but not after a distal gastrectomy.


CONCLUSIONS
These results suggest that postchallenge hyperglycemia after OGTT may become more exacerbated after a total gastrectomy than after a distal gastrectomy. Postprandial hyperglycemia, especially after a total gastrectomy, may therefore be involved in the development of diabetes.
Yamamoto
Hiroshi
H
Department of Surgery, Department of Medicine, Shiga University of Medical Science, Seta-tsukinowa-cho, Otsu, Shiga, 520-2192, Japan.
Tsuchihashi
Hiroshi
H
Akabori
Hiroya
H
Naitoh
Hiroyuki
H
Maegawa
Hiroshi
H
Tani
Tohru
T
D000368:Aged; D000704:Analysis of Variance; D001786:Blood Glucose / Q000032:analysis; D005260:Female; D005743:Gastrectomy / Q000379:methods*; D005951:Glucose Tolerance Test; D006801:Humans; D006943:Hyperglycemia / Q000097:blood / Q000209:etiology*; D007328:Insulin / Q000097:blood; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D019518:Postprandial Period; D011236:Prediabetic State / Q000097:blood / Q000209:etiology*; D012307:Risk Factors; D013274:Stomach Neoplasms / Q000601:surgery
D001786:Blood Glucose; D007328:Insulin