Department of Metabolism, Digestion and Reproduction, Imperial College London, London, U.K.
Department of Surgery and Cancer, Imperial College Healthcare National Health Service Trust, London, U.K.
Diabetes Care. 2021 Feb;44(2):614-617. doi: 10.2337/dc20-1609. Epub 2020 Dec 17.
Roux-en-Y gastric bypass (RYGB) is an established treatment for type 2 diabetes and obesity. The study objective was to establish RYGB's effects on glycemic variability (GV) and hypoglycemia.
This was a prospective observational study of 10 participants with obesity and prediabetes or type 2 diabetes who underwent RYGB. Patients were studied before RYGB (Pre) and 1 month, 1 year, and 2 years postsurgery with continuous glucose measurement (CGM). A mixed-meal test (MMT) was conducted at Pre, 1 month, and 1 year.
After RYGB, mean CGM decreased (at 1 month, 1 year, and 2 years), and GV increased (at 1 year and 2 years). Five of the 10 participants had a percent time in range (%TIR) <3.0 mmol/L (54 mg/dL) greater than the international consensus target of 1% at 1 or 2 years. Peak glucagon-like peptide-1 (GLP-1) and glucagon area under the curve during MMT were positively and negatively associated, respectively, with contemporaneous %TIR <3.0 mmol/L.
Patients undergoing RYGB are at risk for development of postbariatric hypoglycemia due to a combination of reduced mean glucose, increased GV, and increased GLP-1 response.
Roux-en-Y 胃旁路术（RYGB）是治疗 2 型糖尿病和肥胖的一种成熟方法。本研究旨在确定 RYGB 对血糖变异性（GV）和低血糖的影响。
这是一项前瞻性观察研究，纳入了 10 名患有肥胖症和前驱糖尿病或 2 型糖尿病的患者，他们接受了 RYGB 手术。患者在 RYGB 术前（Pre）以及术后 1 个月、1 年和 2 年时接受连续血糖监测（CGM）。在 Pre、1 个月和 1 年时进行混合餐测试（MMT）。
RYGB 后，平均 CGM 降低（在 1 个月、1 年和 2 年时），GV 增加（在 1 年和 2 年时）。在 1 年或 2 年内，10 名患者中有 5 名的时间百分比（%TIR）<3.0mmol/L（54mg/dL）大于国际共识目标的 1%。MMT 期间胰高血糖素样肽-1（GLP-1）和胰高血糖素的 AUC 呈正相关和负相关，分别与同期%TIR<3.0mmol/L 相关。
接受 RYGB 的患者由于平均血糖降低、GV 增加和 GLP-1 反应增加，存在发生减重后低血糖的风险。
