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Postbariatric hypoglycemia: symptom patterns and associated risk factors in the Longitudinal Assessment of Bariatric Surgery study

2021; Elsevier BV; Volume: 17; Issue: 10 Linguagem: Inglês

10.1016/j.soard.2021.04.021

1878-7533

L. Fischer, Bruce M. Wolfe, Nora F. Fino, Miriam R. Elman, David R. Flum, James E. Mitchell, Alfons Pomp, Walter J. Pories, Jonathan Q. Purnell, Mary‐Elizabeth Patti, Paul D. Berk, Marc Bessler, Amna Daud, Harrison Lobdell, Jemela Mwelu, Beth Schrope, Akuezunkpa Ude, Jamie Honohan, Michelle Capasso, Ricardo Costa, Greg Dakin, Faith Ebel, Michel Gagner, Jane Hsieh, Alfons Pomp, Gladys Strain, Rita Bowden, William H. Chapman, Blair Cundiff, M. R. BALL, Emily Cunningham, Lynis Dohm, John R. Pender, Walter J. Pories, J. C. Barker, Michael Howell, Luis García, Kathryn E. Lancaster, Erika Lovaas, James E. Mitchell, Tim Monson, Chelsea Cassady, Emily Coburn, Emily Moher, Clifford W. Deveney, Katherine A. Elder, Stefanie Greene, Jonathan Q. Purnell, Robert W. O’Rourke, Chad Sorenson, Bruce M. Wolfe, Emma Patterson, William J. Raum, Lisa VanDerWerff, Jason Kwiatkowski, Anita P. Courcoulas, William Gourash, Carol A. McCloskey, Ramesh Ramanathan, Melissa A. Kalarchian, Marsha D. Marcus, Eleanor Shirley, Angela Turo, David R. Flum, E. Patchen Dellinger, Saurabh Khandelwal, Skye D. Stewart, Morgan M. Cooley, Rebecca Blissell, Megan Miller, Richard C. Thirlby, Lily Chang, Jeffrey A. Hunter, Ravi Moonka, Debbie M. Ng, Steven H. Belle, Wendy C. King, Debbie Martin, R. Mercurio, Abdus S. Wahed, Frani Averbach, Mary Horlick, Carolyn W. Miles, Myrlene A. Staten, Susan Z. Yanovski, David E. Kleiner,

Diabetes Management and Research

Abstract Background Postbariatric hypoglycemia (PBH) can be a devastating complication for which current therapies are often incompletely effective. More information is needed regarding frequency, incidence, and risk factors for PBH. Objectives To examine hypoglycemia symptoms following Roux-en-Y gastric bypass (RYGB) and laparoscopic adjustable gastric banding (LAGB) and baseline and in-study risk factors. Setting Multicenter, at 10 US hospitals in 6 geographically diverse clinical centers. Methods A prospective, longitudinal cohort study of adults undergoing RYGB or LAGB as part of clinical care between 2006 and 2009 were recruited and followed until January 31, 2015, with baseline and annual postoperative research assessments. We analyzed baseline prevalence and post-operative incidence and frequency of self-reported hypoglycemia symptoms as well as potential preoperative risk factors. Results In all groups, postoperative prevalence of hypoglycemia symptoms was 38.5%. Symptom prevalence increased postoperatively from 2.8%–36.4% after RYGB in patients without preoperative diabetes (T2D), with similar patterns in prediabetes (4.9%–29.1%). Individuals with T2D had higher baseline hypoglycemia symptoms (28.9%), increasing after RYGB (57.9%). Hypoglycemia symptoms were lower after LAGB, with 39.1% reported hypoglycemia symptoms at only 1 postoperative visit with few (4.0%) having persistent symptoms at 6 or more annual visits. Timing of symptoms was not restricted to the postprandial state. Symptoms of severe hypoglycemia were reported in 2.6–3.6% after RYGB. The dominant risk factor for postoperative symptoms was preoperative symptoms; additionally, baseline selective serotonin (SSRI) and serotonin-norepinephrine (SNRI) reuptake inhibitor use was also associated with increased risk in multivariable analysis. Weight loss and regain were not related to hypoglycemia symptom reporting. Conclusion Hypoglycemia symptoms increase over time after RYGB, particularly in patients without diabetes. In a small percentage, symptoms can be persistent or severe and require hospitalization. Preoperative hypoglycemia symptoms and SSRI/SNRI use in RYGB patients without diabetes is associated with increased risk of symptoms.