Hypoglycemia after Roux-En-Y gastric bypass: detection rates of continuous glucose monitoring (CGM) versus mixed meal test.
BACKGROUND
Neuroglucopenic hypoglycemia might be an underestimated threat for roux-en-Y gastric bypass (RYGB) patients leading to fatigue, syncope, seizures or even accidental deaths. Different measurements can assess hypoglycemia such as a finger-stick glucometer, an Oral Glucose Tolerance Test, a Mixed Meal-Test (MMT) or, as introduced recently, continuous glucose monitoring (CGM).


METHODS
University Hospital, Austria.


METHODS
To assess the incidence of hypoglycemic episodes under real life conditions, 5-day CGM was performed in a series of 40 patients at a mean of 86 months after RYGB. The detection rates were compared to a mixed meal-test.


RESULTS
CGM detected hypoglycemic episodes of <55 mg/dL or <3.05 mmol/L in 75% of the patients, while MMT indicated hypoglycemia in 29% of the patients. CGM also detected nocturnal hypoglycemic episodes in 15 (38%) of the patients. A mean of 3±1 hypoglycemic episodes per patient with a mean duration of 71±25 minutes were observed by CGM.


CONCLUSIONS
Assessed under real life conditions by CGM, post-RYGB hypoglycemia was found more frequently than expected. CGM revealed hypoglycemic episodes in 75% of the patients while MMT had a lower detection rate. Thus, CGM may have a role for screening but also for the evaluation of dietary modifications, drug therapy or surgical intervention for hypoglycemia after RYGB.
Department of Surgery, Division of General Surgery, Medical University of Vienna, Vienna, Austria.
Ronald
R
Kefurt
Department of Surgery, Division of General Surgery, Medical University of Vienna, Vienna, Austria.
Felix B
FB
Langer
Department of Internal Medicine 3, Medical University of Vienna, Vienna, Austria.
Karin
K
Schindler
Department of Surgery, Division of General Surgery, Medical University of Vienna, Vienna, Austria.
Soheila
S
Shakeri-Leidenmühler
Department of Internal Medicine 3, Medical University of Vienna, Vienna, Austria.
Bernhard
B
Ludvik
Department of Surgery, Division of General Surgery, Medical University of Vienna, Vienna, Austria. Electronic address: gerhard.prager@meduniwien.ac.at.
Gerhard
G
Prager
D000328:Adult; D001786:Blood Glucose / Q000378:metabolism*; D005260:Female; D005500:Follow-Up Studies; D015390:Gastric Bypass / Q000009:adverse effects*; D005951:Glucose Tolerance Test / Q000379:methods; D006801:Humans; D007003:Hypoglycemia / Q000097:blood / Q000175:diagnosis* / Q000209:etiology; D008297:Male; D062407:Meals; D009767:Obesity, Morbid / Q000601:surgery*; D012189:Retrospective Studies; D013997:Time Factors
D001786:Blood Glucose
Continuous glucose monitoring (CGM); Gastric bypass; Hypoglycemia; Mixed meal test (MMT)