title: Risk Factors for Spontaneously Self-Reported Postprandial Hypoglycemia After Bariatric Surgery.
abstract: Postprandial hypoglycemia (PPHG) is a recognized complication of Roux-en-Y gastric bypass (RYGB) surgery. Data on PPHG after laparoscopic sleeve gastrectomy (LSG) are scant.
  
  
  
  The objective of the study was to identify preoperative predictors of PPHG in subjects spontaneously self-reporting PPHG after RYGB or LSG. Patients, Setting, and Intervention: Nondiabetic patients spontaneously self-reporting symptoms/signs of PPHG (PPHG group, 21 RYGB and 11 LSG) were compared in a case-control design with subjects who never experienced spontaneous or oral glucose tolerance test (OGTT)-induced hypoglycemia over 24 months after surgery (No-PPHG group, 13 RYGB and 40 LSG). Paired pre- and postoperative 3-hour OGTTs were analyzed in all participants.
  
  
  
  Insulin sensitivity was assessed by the oral glucose insulin sensitivity index and β-cell function by mathematical modeling of the C-peptide response to glucose.
  
  
  
  Before surgery, the body mass index was lower in PPHG than No-PPHG patients in the RYGB (P = .002) and trended similarly in the LSG group (P = .08). Fasting glycemia and the glucose-OGTT nadir were lower in the PPHG than the No-PPHG subjects in both surgery groups. Before surgery, insulin sensitivity was higher in PPHG than No-PPHG in the RYGB (393 ± 55 vs 325 ± 44 mL/min-1· m-2, P = .001) and LSG groups (380 ± 48 vs 339 ± 60 mL/min-1· m-2, P = .05) and improved to a similar extent in all groups after surgery. Before surgery, β-cell glucose sensitivity was higher in PPHG than No-PPHG in both RYGB (118 ± 67 vs 65 ± 24 pmol/min-1· m2· mM-1) and LSG patients (114 ± 32 vs 86 ± 33) (both P = .02) and improved in all subjects after surgery.
  
  
  
  In subjects self-reporting PPHG after surgery, lower presurgery plasma glucose concentrations, higher insulin sensitivity, and better β-cell glucose sensitivity are significant predictors of PPHG after both RYGB and LSG.
authors.affiliation: Department of Clinical and Experimental Medicine (M.N., D.G., D.M., S.B.), University of Pisa, 56126 Pisa, Italy; Departments of Medicine (A.B., L.B., R.F., R.V.) and Oncology and Surgery Science (M.F.), University of Padua, 35122 Padua, Italy; National Research Council Institute of Neurosciences (A.M.), Padua, Italy; Bariatric Surgery Unit (M.A.), Santa Chiara Hospital, 56100 Pisa, Italy; National Research Council Institute of Clinical Physiology (E.F.), 56124 Pisa, Italy.
authors.forename: Monica
authors.initials: M
authors.lastname: Nannipieri
authors.affiliation: Department of Clinical and Experimental Medicine (M.N., D.G., D.M., S.B.), University of Pisa, 56126 Pisa, Italy; Departments of Medicine (A.B., L.B., R.F., R.V.) and Oncology and Surgery Science (M.F.), University of Padua, 35122 Padua, Italy; National Research Council Institute of Neurosciences (A.M.), Padua, Italy; Bariatric Surgery Unit (M.A.), Santa Chiara Hospital, 56100 Pisa, Italy; National Research Council Institute of Clinical Physiology (E.F.), 56124 Pisa, Italy.
authors.forename: Anna
authors.initials: A
authors.lastname: Belligoli
authors.affiliation: Department of Clinical and Experimental Medicine (M.N., D.G., D.M., S.B.), University of Pisa, 56126 Pisa, Italy; Departments of Medicine (A.B., L.B., R.F., R.V.) and Oncology and Surgery Science (M.F.), University of Padua, 35122 Padua, Italy; National Research Council Institute of Neurosciences (A.M.), Padua, Italy; Bariatric Surgery Unit (M.A.), Santa Chiara Hospital, 56100 Pisa, Italy; National Research Council Institute of Clinical Physiology (E.F.), 56124 Pisa, Italy.
authors.forename: Daniela
authors.initials: D
authors.lastname: Guarino
authors.affiliation: Department of Clinical and Experimental Medicine (M.N., D.G., D.M., S.B.), University of Pisa, 56126 Pisa, Italy; Departments of Medicine (A.B., L.B., R.F., R.V.) and Oncology and Surgery Science (M.F.), University of Padua, 35122 Padua, Italy; National Research Council Institute of Neurosciences (A.M.), Padua, Italy; Bariatric Surgery Unit (M.A.), Santa Chiara Hospital, 56100 Pisa, Italy; National Research Council Institute of Clinical Physiology (E.F.), 56124 Pisa, Italy.
authors.forename: Luca
authors.initials: L
authors.lastname: Busetto
authors.affiliation: Department of Clinical and Experimental Medicine (M.N., D.G., D.M., S.B.), University of Pisa, 56126 Pisa, Italy; Departments of Medicine (A.B., L.B., R.F., R.V.) and Oncology and Surgery Science (M.F.), University of Padua, 35122 Padua, Italy; National Research Council Institute of Neurosciences (A.M.), Padua, Italy; Bariatric Surgery Unit (M.A.), Santa Chiara Hospital, 56100 Pisa, Italy; National Research Council Institute of Clinical Physiology (E.F.), 56124 Pisa, Italy.
authors.forename: Diego
authors.initials: D
authors.lastname: Moriconi
authors.affiliation: Department of Clinical and Experimental Medicine (M.N., D.G., D.M., S.B.), University of Pisa, 56126 Pisa, Italy; Departments of Medicine (A.B., L.B., R.F., R.V.) and Oncology and Surgery Science (M.F.), University of Padua, 35122 Padua, Italy; National Research Council Institute of Neurosciences (A.M.), Padua, Italy; Bariatric Surgery Unit (M.A.), Santa Chiara Hospital, 56100 Pisa, Italy; National Research Council Institute of Clinical Physiology (E.F.), 56124 Pisa, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Fabris
authors.affiliation: Department of Clinical and Experimental Medicine (M.N., D.G., D.M., S.B.), University of Pisa, 56126 Pisa, Italy; Departments of Medicine (A.B., L.B., R.F., R.V.) and Oncology and Surgery Science (M.F.), University of Padua, 35122 Padua, Italy; National Research Council Institute of Neurosciences (A.M.), Padua, Italy; Bariatric Surgery Unit (M.A.), Santa Chiara Hospital, 56100 Pisa, Italy; National Research Council Institute of Clinical Physiology (E.F.), 56124 Pisa, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Mari
authors.affiliation: Department of Clinical and Experimental Medicine (M.N., D.G., D.M., S.B.), University of Pisa, 56126 Pisa, Italy; Departments of Medicine (A.B., L.B., R.F., R.V.) and Oncology and Surgery Science (M.F.), University of Padua, 35122 Padua, Italy; National Research Council Institute of Neurosciences (A.M.), Padua, Italy; Bariatric Surgery Unit (M.A.), Santa Chiara Hospital, 56100 Pisa, Italy; National Research Council Institute of Clinical Physiology (E.F.), 56124 Pisa, Italy.
authors.forename: Simona
authors.initials: S
authors.lastname: Baldi
authors.affiliation: Department of Clinical and Experimental Medicine (M.N., D.G., D.M., S.B.), University of Pisa, 56126 Pisa, Italy; Departments of Medicine (A.B., L.B., R.F., R.V.) and Oncology and Surgery Science (M.F.), University of Padua, 35122 Padua, Italy; National Research Council Institute of Neurosciences (A.M.), Padua, Italy; Bariatric Surgery Unit (M.A.), Santa Chiara Hospital, 56100 Pisa, Italy; National Research Council Institute of Clinical Physiology (E.F.), 56124 Pisa, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Anselmino
authors.affiliation: Department of Clinical and Experimental Medicine (M.N., D.G., D.M., S.B.), University of Pisa, 56126 Pisa, Italy; Departments of Medicine (A.B., L.B., R.F., R.V.) and Oncology and Surgery Science (M.F.), University of Padua, 35122 Padua, Italy; National Research Council Institute of Neurosciences (A.M.), Padua, Italy; Bariatric Surgery Unit (M.A.), Santa Chiara Hospital, 56100 Pisa, Italy; National Research Council Institute of Clinical Physiology (E.F.), 56124 Pisa, Italy.
authors.forename: Mirto
authors.initials: M
authors.lastname: Foletto
authors.affiliation: Department of Clinical and Experimental Medicine (M.N., D.G., D.M., S.B.), University of Pisa, 56126 Pisa, Italy; Departments of Medicine (A.B., L.B., R.F., R.V.) and Oncology and Surgery Science (M.F.), University of Padua, 35122 Padua, Italy; National Research Council Institute of Neurosciences (A.M.), Padua, Italy; Bariatric Surgery Unit (M.A.), Santa Chiara Hospital, 56100 Pisa, Italy; National Research Council Institute of Clinical Physiology (E.F.), 56124 Pisa, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Vettor
authors.affiliation: Department of Clinical and Experimental Medicine (M.N., D.G., D.M., S.B.), University of Pisa, 56126 Pisa, Italy; Departments of Medicine (A.B., L.B., R.F., R.V.) and Oncology and Surgery Science (M.F.), University of Padua, 35122 Padua, Italy; National Research Council Institute of Neurosciences (A.M.), Padua, Italy; Bariatric Surgery Unit (M.A.), Santa Chiara Hospital, 56100 Pisa, Italy; National Research Council Institute of Clinical Physiology (E.F.), 56124 Pisa, Italy.
authors.forename: Ele
authors.initials: E
authors.lastname: Ferrannini
mesh_terms: D000328:Adult; D050110:Bariatric Surgery / Q000009:adverse effects*; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D007003:Hypoglycemia / Q000097:blood / Q000175:diagnosis* / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000601:surgery*; D017063:Outcome Assessment, Health Care; D011379:Prognosis; D012307:Risk Factors; D057566:Self Report