Research Division, Joslin Diabetes Center, Boston 02215, MA, USA.
Morehouse School of Medicine, Atlanta 30310, GA, USA.
J Clin Endocrinol Metab. 2021 Jul 13;106(8):2291-2303. doi: 10.1210/clinem/dgab323.
Severe hypoglycemia with neuroglycopenia, termed post-bariatric hypoglycemia (PBH). typically occurs postprandially, but it is also reported after activity or mid-nocturnally.
To quantify glycemia, glycemic variability, and magnitude/duration of low sensor glucose (SG) values in patients with PBH after Roux-en-Y gastric bypass (PBH-RYGB).
This retrospective analysis of data from an academic medical center included individuals with PBH-RYGB (n = 40), reactive hypoglycemia without gastrointestinal surgery (Non-Surg Hypo, n = 20), prediabetes (Pre-DM, n = 14), newly diagnosed T2D (n = 5), and healthy controls (HC, n = 38). Masked continuous glucose monitoring (Dexcom G4) was used to assess patterns over 24 hours, daytime (6 am-midnight) and nighttime (midnight-6 am). Prespecified measures included mean and median SG, variability, and percent time at thresholds of sensor glucose.
Mean and median SG were similar for PBH-RYGB and HC (mean: 99.8 ± 18.6 vs 96.9 ± 10.2 mg/dL; median: 93.0 ± 14.8 vs 94.5 ± 7.4 mg/dL). PBH-RYGB had a higher coefficient of variation (27.3 ± 6.8 vs 17.9 ± 2.4%, P < 0.0001) and range (154.5 ± 50.4 vs 112.0 ± 26.7 mg/dL, P < 0.0001). Nadir was lowest in PBH-RYGB (42.5 ± 3.7 vs HC 49.0 ± 11.9 mg/dL, P = 0.0046), with >2-fold greater time with SG < 70 mg/dL vs HC (7.7 ± 8.4 vs 3.2 ± 4.1%, P = 0.0013); these differences were greater at night (12.6 ± 16.9 vs 1.0 ± 1.5%, P < 0.0001). Non-Surg Hypo also had 4-fold greater time with SG < 70 at night vs HC (SG < 70: 4.0 ± 5.9% vs 1.0 ± 1.5%), but glycemic variability was not increased.
Patients with PBH-RYGB experience higher glycemic variability and frequency of SG < 70 compared to HC, especially at night. These data suggest that additional pathophysiologic mechanisms beyond prandial changes contribute to PBH.
严重低血糖伴神经低血糖，称为减重手术后低血糖（PBH），通常发生在餐后，但也有报道发生在活动后或午夜。
定量检测 PBH-RYGB 后患者的血糖、血糖变异性以及低传感器血糖（SG）值的幅度/持续时间。
本研究回顾性分析了来自学术医疗中心的数据，包括 PBH-RYGB 患者（n=40）、无胃肠手术的反应性低血糖（Non-Surg Hypo，n=20）、前驱糖尿病（Pre-DM，n=14）、新诊断的 2 型糖尿病（T2D，n=5）和健康对照组（HC，n=38）。使用 Dexcom G4 进行连续血糖监测（CGM），以评估 24 小时、白天（6 am-午夜）和夜间（午夜-6 am）的血糖模式。预设的指标包括传感器血糖的平均和中位数、变异性以及各时间点的血糖阈值。
PBH-RYGB 组与 HC 组的平均和中位数 SG 相似（均值：99.8±18.6 vs 96.9±10.2 mg/dL；中位数：93.0±14.8 vs 94.5±7.4 mg/dL）。PBH-RYGB 组的变异系数（27.3±6.8% vs 17.9±2.4%，P<0.0001）和范围（154.5±50.4 vs 112.0±26.7 mg/dL，P<0.0001）均较高。最低点在 PBH-RYGB 组最低（42.5±3.7 vs HC 49.0±11.9 mg/dL，P=0.0046），且 SG<70 mg/dL 的时间比 HC 组长两倍多（7.7±8.4% vs 3.2±4.1%，P=0.0013）；夜间差异更大（12.6±16.9 vs 1.0±1.5%，P<0.0001）。Non-Surg Hypo 组夜间 SG<70 的时间也比 HC 组长 4 倍（SG<70：4.0±5.9% vs 1.0±1.5%），但血糖变异性并未增加。
与 HC 相比，PBH-RYGB 患者的血糖变异性和 SG<70 的频率更高，尤其是在夜间。这些数据表明，除了餐后变化外，还有其他病理生理机制导致 PBH。
