Halperin Florencia, Patti Mary Elizabeth, Skow Megan, Bajwa Muhammad, Goldfine Allison B
Brigham and Women's Hospital, Boston 02115, MA, USA.
J Obes. 2011;2011:869536. doi: 10.1155/2011/869536. Epub 2011 Feb 7.
Background. Hyperinsulinemic hypoglycemia with neuroglycopenia is a rare complication of Roux-en-Y gastric bypass (RYGB). We hypothesized that continuous glucose monitoring (CGM) would be useful to characterize glycemic variability after RYGB. Methods. CGM and mixed meal tolerance testing (MMTT) were performed on sixteen post-RYGB subjects, ten with a history of neuroglycopenia on medical treatment and six asymptomatic controls. Results. 9 of 10 subjects with neuroglycopenia developed hypoglycemia defined by glucose <70 mg/dL on CGM, and 3 of 9 on MMTT. In asymptomatic subjects, 3 of 6 had asymptomatic hypoglycemia during CGM, and 3 of 5 on MMTT. Therefore, the sensitivity and specificity to detect clinically significant hypoglycemia was 90% and 50% for CGM and 33% and 40% for MMTT. Conclusions. Asymptomatic hypoglycemia after RYGB is more frequent than commonly recognized. For clinicians evaluating patients for postbypass neuroglycopenia, CGM may be a valuable diagnostic tool.
背景。伴有神经低血糖症的高胰岛素血症性低血糖是Roux-en-Y胃旁路术（RYGB）的一种罕见并发症。我们推测持续葡萄糖监测（CGM）有助于描述RYGB术后的血糖变异性。方法。对16名RYGB术后患者进行了CGM和混合餐耐量试验（MMTT），其中10名有接受药物治疗的神经低血糖症病史，6名无症状对照者。结果。10名有神经低血糖症的患者中，9名在CGM时出现血糖<70mg/dL定义的低血糖，9名中的3名在MMTT时出现低血糖。在无症状受试者中，6名中的3名在CGM期间出现无症状性低血糖，5名中的3名在MMTT时出现无症状性低血糖。因此，CGM检测临床显著低血糖的敏感性和特异性分别为90%和50%，MMTT分别为33%和40%。结论。RYGB术后无症状性低血糖比普遍认为的更常见。对于评估患者旁路术后神经低血糖症的临床医生来说，CGM可能是一种有价值的诊断工具。
