title: Risk of post-gastric bypass surgery hypoglycemia in nondiabetic individuals: A single center experience.
abstract: The epidemiology of post-gastric bypass surgery hypoglycemia (PGBH) is incompletely understood. This study aimed to evaluate the risk of PGBH among nondiabetic patients and associated factors.
  
  
  
  A cohort study of nondiabetic patients who underwent Roux-en-Y gastric bypass (RYGB) was conducted. PGBH was defined by any postoperative record of glucose < 60 mg/dL, diagnosis of hypoglycemia, or any medication use for treatment of PGBH. Kaplan-Meier analysis was used to describe PGBH occurrence, log-rank tests, and Cox regression to examine associated factors.
  
  
  
  Of the 1,206 eligible patients, 86% were female with mean age of 43.7 years, mean preoperative BMI of 48.7 kg/m(2) , and a mean follow-up of 4.8 years. The cumulative incidence of hypoglycemia at 1 and 5 years post-RYGB was 2.7% and 13.3%, respectively. Incidence of PGBH was identified in 158 patients and was associated with lower preoperative BMI (P = 0.048), lower preoperative HbA1c (P = 0.012), and higher 6-month percent of excess body weight loss (%EWL) (P = 0.001). A lower preoperative HbA1c (HR = 1.73, P = 0.0034) and higher 6-month %EWL (HR = 1.96, P = 0.0074) remained independently correlated with increased risk for PGBH in multi-regression analysis.
  
  
  
  The 5-year incidence of PGBH among nondiabetic individuals was 13.3% and was associated with a lower preoperative HbA1c and greater weight loss at 6 months following surgery.
authors.affiliation: Division of Endocrinology, Diabetes & Metabolism, Department of Medicine, the Johns Hopkins University, Baltimore, Maryland, USA.
authors.forename: Clare J
authors.initials: CJ
authors.lastname: Lee
authors.affiliation: Geisinger Obesity Research Institute, Geisinger Clinic, Danville, Pennsylvania, USA.
authors.forename: G Craig
authors.initials: GC
authors.lastname: Wood
authors.affiliation: Division of General Internal Medicine, Department of Medicine, the Johns Hopkins University, Baltimore, Maryland, USA.
authors.forename: Mariana
authors.initials: M
authors.lastname: Lazo
authors.affiliation: Division of Endocrinology, Diabetes & Metabolism, Department of Medicine, the Johns Hopkins University, Baltimore, Maryland, USA.
authors.forename: Todd T
authors.initials: TT
authors.lastname: Brown
authors.affiliation: Division of General Internal Medicine, Department of Medicine, the Johns Hopkins University, Baltimore, Maryland, USA.
authors.forename: Jeanne M
authors.initials: JM
authors.lastname: Clark
authors.affiliation: Geisinger Obesity Research Institute, Geisinger Clinic, Danville, Pennsylvania, USA.
authors.forename: Christopher
authors.initials: C
authors.lastname: Still
authors.affiliation: Geisinger Obesity Research Institute, Geisinger Clinic, Danville, Pennsylvania, USA.
authors.forename: Peter
authors.initials: P
authors.lastname: Benotti
mesh_terms: D000328:Adult; D001786:Blood Glucose / Q000378:metabolism; D015992:Body Mass Index; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D015390:Gastric Bypass / Q000009:adverse effects*; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D007003:Hypoglycemia / Q000097:blood* / Q000453:epidemiology* / Q000209:etiology; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000601:surgery; D011184:Postoperative Period; D016016:Proportional Hazards Models; D012307:Risk Factors; D015431:Weight Loss
chemical_list: D001786:Blood Glucose; D006442:Glycated Hemoglobin