title: Usefulness of acarbose and dietary modifications to limit glycemic variability following Roux-en-Y gastric bypass as assessed by continuous glucose monitoring.
abstract: BACKGROUND
  About 70% of the patients operated on for a gastric bypass (Roux-en-Y gastric bypass [RYGB]) suffer from dumping syndrome. In these patients, previous studies have demonstrated a high glycemic variability with hypoglycemia and with altered continuous glucose monitoring (CGM) profiles. The aim of this study was to evaluate the effect of treatment with dietary counseling plus acarbose administration on the symptoms and on the characteristics of the CGM profile.
  
  
  METHODS
  Eight consecutive patients with dumping syndrome were given dietary counseling for 6 weeks and also treated with acarbose (50-100 mg three times a day). Their symptoms and the features of the CGM were compared before and after treatment.
  
  
  RESULTS
  The symptoms disappeared in seven patients. There was a significant increase in the time to the interstitial glucose (IG) peak and a reduction in the rate of the IG increase after a meal and in the rate of the IG decrease following the peak. The time below 60 mg/dL was significantly decreased, and the minimal IG value was significantly increased. The maximum and mean IG levels and the time above 140 mg/dL were decreased, but not significantly. Six patients spent more than 1% of the time with IG values below 60 mg/dL before treatment, but after treatment this was reduced to one patient. Before treatment only one patient had an IG level neither below 60 or above 140 mg/dL, and after treatment four patients were in this category.
  
  
  CONCLUSIONS
  Dietary counseling and acarbose treatment eliminated the symptoms and improved the CGM profile of patients suffering from dumping syndrome after RYGB.
authors.affiliation: Nutrition Unit, Cardiovascular and Metabolism Division, CHU of Toulouse, Hospital Larrey, Toulouse Cedex 09, France. Patrick.ritz@wanadoo.fr
authors.forename: Patrick
authors.initials: P
authors.lastname: Ritz
authors.forename: Charlotte
authors.initials: C
authors.lastname: Vaurs
authors.forename: Monelle
authors.initials: M
authors.lastname: Bertrand
authors.forename: Yves
authors.initials: Y
authors.lastname: Anduze
authors.forename: Eric
authors.initials: E
authors.lastname: Guillaume
authors.forename: Helene
authors.initials: H
authors.lastname: Hanaire
mesh_terms: D020909:Acarbose / Q000627:therapeutic use*; D000328:Adult; D001786:Blood Glucose / Q000378:metabolism*; D015190:Blood Glucose Self-Monitoring / Q000379:methods*; D037001:Directive Counseling; D004377:Dumping Syndrome / Q000097:blood / Q000178:diet therapy* / Q000188:drug therapy* / Q000209:etiology; D005247:Feeding Behavior; D005260:Female; D015390:Gastric Bypass / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000097:blood / Q000601:surgery*; D016896:Treatment Outcome
chemical_list: D001786:Blood Glucose; D020909:Acarbose