title: Acarbose improves hypoglycaemia following gastric bypass surgery without increasing glucagon-like peptide 1 levels.
abstract: BACKGROUND
  Postprandial hypoglycaemia is a severe complication of Roux-en-Y gastric bypass (RYGBP). Acarbose, an α-glucosidase inhibitor (AGI), is employed in its treatment. Several studies have shown that AGIs increase the postprandial levels of glucagon-like peptide 1 (GLP-1). However, an excessive level of GLP-1 is one of the factors involved in the physiopathology of this condition. We analysed the effect of acarbose oral administration in eight RYBGP patients with clinically significant hypoglycaemia or dumping syndrome.
  
  
  METHODS
  Glucose, insulin and GLP-1 plasma levels in fasting and after ingestion of a standard meal (Ensure Plus®; 13 g protein, 50 g carbohydrate, 11 g fat) were measured. The test was repeated the following week with the oral administration of 100 mg of acarbose 15 min prior to the meal.
  
  
  RESULTS
  Five patients developed asymptomatic hypoglycaemia during the test (glucose level <50 mg/dl) with inappropriately high insulin levels and exaggerated GLP-1 response. Acarbose ingestion avoided hypoglycaemia in all of the patients and increased the lowest plasma glucose level (46.4 ± 4.8 vs. 59.0 ± 2.6 mg/dl, p < 0.01). Acarbose ingestion decreased the area under the curve for serum insulin and GLP-1 levels at 15 min after the meal.
  
  
  CONCLUSIONS
  Acarbose avoided postprandial hypoglycaemia following RYGBP by decreasing the hyperinsulinemic response. This was associated with a decrease in early GLP-1 secretion, in contrast to that observed in non-surgical subjects. This finding could be explained by the reduction of glucose load in the jejunum produced by the α-glucosidase inhibition, which is the main stimulus for GLP-1 secretion.
authors.affiliation: Department of Nutrition, Diabetes and Metabolism, School of Medicine, Pontificia Universidad Catolica de Chile, Santiago, Chile. jpvalder@uc.cl
authors.forename: Juan Patricio
authors.initials: JP
authors.lastname: Valderas
authors.forename: Jessica
authors.initials: J
authors.lastname: Ahuad
authors.forename: Lorena
authors.initials: L
authors.lastname: Rubio
authors.forename: Manuel
authors.initials: M
authors.lastname: Escalona
authors.forename: Felipe
authors.initials: F
authors.lastname: Pollak
authors.forename: Alberto
authors.initials: A
authors.lastname: Maiz
mesh_terms: D020909:Acarbose / Q000008:administration & dosage / Q000627:therapeutic use*; D000284:Administration, Oral; D000328:Adult; D001786:Blood Glucose / Q000187:drug effects* / Q000378:metabolism; D003920:Diabetes Mellitus / Q000097:blood / Q000188:drug therapy*; D004377:Dumping Syndrome / Q000097:blood / Q000188:drug therapy* / Q000209:etiology / Q000517:prevention & control; D005260:Female; D015390:Gastric Bypass / Q000009:adverse effects*; D052216:Glucagon-Like Peptide 1 / Q000097:blood* / Q000187:drug effects; D006801:Humans; D007003:Hypoglycemia / Q000097:blood / Q000188:drug therapy* / Q000209:etiology / Q000517:prevention & control; D007328:Insulin / Q000097:blood; D008297:Male; D009767:Obesity, Morbid / Q000097:blood / Q000601:surgery*; D019518:Postprandial Period; D016896:Treatment Outcome
chemical_list: D001786:Blood Glucose; D007328:Insulin; D052216:Glucagon-Like Peptide 1; D020909:Acarbose