Department of Endocrinology, Diabetology and Nutrition, University of Lorraine, CHRU Nancy, Brabois Hospital, Nancy, France.
Department of Visceral, Metabolic and Cancer Surgery (CVMC), Multidisciplinary Unit for Obesity Surgery (UMCO), University of Lorraine, CHRU Nancy, Brabois Hospital, Vandoeuvre-lès-Nancy, France.
Obesity (Silver Spring). 2021 Apr;29(4):681-688. doi: 10.1002/oby.23118. Epub 2021 Feb 19.
After Roux-en-Y gastric bypass (RYGB), postprandial hyperinsulinemic hypoglycemia (PPHH) is particularly critical because of the risk of trauma. The aim of this study was to assess the incidence and identify risk factors for symptomatic PPHH.
Patients with RYGB were classified into moderate PPHH (MH) or severe hypoglycemia (SH), which is defined as patients with neuroglycopenic symptoms. Logistic multivariate linear regressions were performed to identify predictive factors for symptomatic PPHH and more specifically for SH with neuroglycopenic symptoms. Patients with diabetes and those with a follow-up shorter than 2 years were excluded.
Among the 1,138 patients, 44.2% had at least one episode of hypoglycemia with a mean delay of 25.5 (21.3) months, 32.6% had MH, and 11.6% had SH. The annual incidence rate of SH was 2.5% the first year, 3.7% the second year, and 1.5% the third year. Independent predictive factors for higher risk of SH were: younger age (odds ratio [OR] = 1.01; 95% CI: 1.05-16.69; P = 0.0007), lower BMI after RYGB (OR = 1.61; 95% CI: 1.17-2.22; P = 0.0035), and maximal weight loss (OR = 1.04; 95% CI = 1.39-1.23; P = 0.0106), whereas higher preoperative BMI was protective (OR = 0.78; 95% CI: 0.64-0.95; P = 0.0112).
This observational cohort study showed that the incidence of severe PPHH with neuroglycopenic symptoms after RYGB was higher than expected.
胃旁路手术后（RYGB）后，发生餐后高胰岛素血症性低血糖（PPHH）特别危险，因为存在创伤风险。本研究旨在评估其发病率，并确定有症状的 PPHH 的危险因素。
将接受 RYGB 的患者分为中度 PPHH（MH）或严重低血糖（SH），后者定义为有神经低血糖症状的患者。进行多变量逻辑线性回归，以确定有症状的 PPHH 的预测因素，更具体地说，是确定有神经低血糖症状的 SH 的预测因素。排除患有糖尿病的患者和随访时间短于 2 年的患者。
在 1138 名患者中，44.2%至少有一次低血糖发作，平均延迟 25.5（21.3）个月，32.6%有 MH，11.6%有 SH。SH 的年发生率为第一年 2.5%，第二年 3.7%，第三年 1.5%。SH 风险较高的独立预测因素为：年龄较小（比值比 [OR] = 1.01；95%可信区间：1.05-16.69；P = 0.0007）、RYGB 后 BMI 较低（OR = 1.61；95%可信区间：1.17-2.22；P = 0.0035）和最大减重（OR = 1.04；95%可信区间 = 1.39-1.23；P = 0.0106），而术前 BMI 较高则具有保护作用（OR = 0.78；95%可信区间：0.64-0.95；P = 0.0112）。
这项观察性队列研究表明，RYGB 后严重的伴有神经低血糖症状的 PPHH 发病率高于预期。
