Postbariatric hypoglycemia: symptom patterns and associated risk factors in the Longitudinal Assessment of Bariatric Surgery study |
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| Affiliation: | 1. Department of Surgery, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma;2. Departments of Medicine, Surgery, and the School of Public Health at Oregon Health & Science University, Portland, Oregon;3. Oregon Health and Science – Portland State University School of Public Health, Portland, Oregon;4. Department of Surgery, University of Washington, Seattle, Washington;5. Department of Psychiatry and Behavioral Science, University of North Dakota School of Medicine, Grand Forks, North Dakota;6. Department of Surgery, University of Montreal, Montreal, Quebec, Canada;7. Metabolic Surgery Research Group, East Carolina University, Greenville, North Carolina;8. Research Division, Joslin Diabetes Center, Harvard Medical School, Boston, Massachusetts;1. Department of General Surgery, Temple University Hospital, Philadelphia, Pennsylvania;2. Department of Minimally Invasive and Bariatric Surgery, Temple University Hospital, Philadelphia, Pennsylvania;3. Department of Clinical Sciences, Temple University Hospital, Philadelphia, Pennsylvania;4. Department of Medical Genetics and Molecular Biochemistry, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania;1. Texas Tech University Health Sciences Center El Paso, Paul L. Foster School of Medicine, El Paso, Texas;2. Department of Surgery, Mayo Clinic, Rochester, Minnesota;3. Universidad Autonoma de Guadelajara, Guadelajara, Mexico;1. University of Ottawa, Department of Medicine, Ottawa, Ontario, Canada;2. Queen’s University, Department of Public Health Sciences, Kingston, Ontario, Canada;3. Queen’s University, Department of Surgery, Kingston, Ontario, Canada;4. McMaster University, Hamilton, Ontario, Canada;1. Department of Gastroenterology, Health Research Institute (IDIS), University Hospital of Santiago de Compostela, Santiago de Compostela, Spain;2. Department of Endocrinology, University Hospital of Santiago de Compostela, Santiago de Compostela, Spain;1. Department of Surgery, Geisinger Wyoming Valley Medical Center, Wilkes Barre, Pennsylvania;2. Department of Surgery, Geisinger Medical Center, Danville, Pennsylvania;3. Department of Surgery, Geisinger Community Medical Center, Scranton, Pennsylvania;1. The Johns Hopkins University School of Medicine, Baltimore, Maryland;2. Department of Medicine, Division of General Internal Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland;3. Department of Epidemiology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland;4. Department of Surgery, The Johns Hopkins University, Baltimore, Maryland;5. Department of Medicine, Division of Endocrinology, Diabetes and Metabolism, The Johns Hopkins University School of Medicine, Baltimore, Maryland |
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| Abstract: | BackgroundPostbariatric 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.ObjectivesTo examine hypoglycemia symptoms following Roux-en-Y gastric bypass (RYGB) and laparoscopic adjustable gastric banding (LAGB) and baseline and in-study risk factors.SettingMulticenter, at 10 US hospitals in 6 geographically diverse clinical centers.MethodsA 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.ResultsIn 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.ConclusionHypoglycemia 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. |
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| Keywords: | Bariatric surgery Roux-en-Y gastric bypass Laparoscopic adjustable gastric band Hypoglycemia SSRI SNRI Diabetes |
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