Tramunt Blandine, Vaurs Charlotte, Lijeron Jocelyne, Guillaume Eric, Ritz Patrick, Diméglio Chloé, Hanaire Hélène
Department of Diabetology, Metabolic Diseases, and Nutrition, CHU Toulouse, Toulouse, France.
Department of Diabetology, Metabolic Diseases, and Nutrition, Hôpital Rangueil - TSA 50032, 31059, Toulouse cedex 9, France.
Obes Surg. 2016 Jul;26(7):1487-92. doi: 10.1007/s11695-015-1930-1.
Abnormal glucose profiles have been described after Roux-en-Y gastric bypass (RYGB) with intense postprandial hyperglycemic peaks in some but not all the patients. The underlying mechanisms of these anomalies are not totally understood.
The aim of this study is to determine whether or not the composition of the meal impacts the existence and maximum interstitial glucose (IG) concentration, measured under real-life conditions.
Retrospective cohort.
Referral bariatric surgery left.
Continuous glucose monitoring (CGM) and meal composition were recorded for at least 3 days on an outpatient basis in 56 patients after RYGB. The presence of postprandial peaks defined by IG above 140 mg/dl, the maximum postprandial IG, the carbohydrate content, and the glycemic load of the meals were analyzed.
Thirty-two patients had a hyperglycemic peak (PEAK), and 24 did not (NO PEAK). The average max IG was 159.6 ± 33.0 mg/dl in PEAK individuals and 111.8 ± 13.0 mg/dl in NO PEAK. Age was significantly higher in PEAK, but no other parameter was different between the two groups, including meal composition. In the PEAK patients, in multivariate analyses, carbohydrate content in model one and glucose load in model two explained respectively 50 and 26 % of maximum IG variance. For each gram of ingested carbohydrates, interstitial glucose increased by 1.68 mg/dl.
Following a gastric bypass, under real-life conditions, irrespective of the carbohydrate content of the meal, some patients develop postprandial hyperglycemic peaks, whereas others do not. In patients with postprandial hyperglycemic peaks, the maximum IG depends on the carbohydrate content of the meal.
在接受Roux-en-Y胃旁路术（RYGB）后，部分而非所有患者出现了异常的血糖曲线，伴有强烈的餐后高血糖峰值。这些异常现象的潜在机制尚未完全明确。
本研究旨在确定膳食组成是否会影响在实际生活条件下测得的餐后血糖峰值的出现情况以及最大组织间液葡萄糖（IG）浓度。
回顾性队列研究。
转诊减肥手术中心。
对56例接受RYGB术后的患者进行门诊随访，连续至少3天记录其动态血糖监测（CGM）情况和膳食组成。分析餐后IG高于140mg/dl所定义的餐后峰值的存在情况、餐后最大IG、碳水化合物含量以及膳食的血糖负荷。
32例患者出现高血糖峰值（PEAK组），24例未出现（NO PEAK组）。PEAK组的平均最大IG为159.6±33.0mg/dl，NO PEAK组为111.8±13.0mg/dl。PEAK组患者的年龄显著更高，但两组之间的其他参数无差异，包括膳食组成。在PEAK组患者中，多因素分析显示，模型一中的碳水化合物含量和模型二中的葡萄糖负荷分别解释了最大IG变异的50%和26%。每摄入1克碳水化合物，组织间液葡萄糖升高1.68mg/dl。
胃旁路术后，在实际生活条件下，无论膳食中的碳水化合物含量如何，部分患者会出现餐后高血糖峰值，而其他患者则不会。在出现餐后高血糖峰值的患者中，最大IG取决于膳食中的碳水化合物含量。
