Toraih Eman A, Doma Mohamed, Atwal Aria Kaur, Vlassis Benito, Abdelmaksoud Ahmed, Aiash Hani, Acharya Runa
Tulane University, New Orleans, LA, USA.
Suez Canal University, Ismailia, Egypt.
Obes Surg. 2024 Dec;34(12):4385-4392. doi: 10.1007/s11695-024-07565-y. Epub 2024 Nov 13.
Roux-en-Y gastric bypass (RYGB) surgery is an effective treatment for obesity. However, the incidence and long-term risk of hypoglycemia after surgery in patients without diabetes remains unclear. This study aimed to investigate the prevalence of hypoglycemia following RYGB surgery in patients with obesity and without diabetes.
A retrospective cohort study was conducted using the TriNetX database. The study population included 15,085 patients with obesity (BMI ≥ 30 kg/m) who underwent RYGB surgery and 3,200,074 non-surgical controls, all without a history of diabetes or GLP-1 receptor agonist use. Propensity score matching was performed to balance baseline characteristics. The primary outcome was the incidence of hypoglycemia, defined by ICD-10-CM codes or laboratory values (glucose ≤ 70 mg/dL). Cox regression analysis was employed to calculate hazard ratios (HR) and 95% confidence intervals (CI).
In the overall study population, the risk of hypoglycemia was significantly higher in the RYGB group (18.70%, n = 2,810) compared to the control group (3.80%, n = 120,923; HR 4.3, 95% CI 4.14-4.46, p < 0.001). After propensity score matching (n = 14,916 per group), RYGB patients maintained an elevated risk (18.70%, n = 2,795) compared to matched controls (5.0%, n = 749; HR 3.7, 95% CI 3.44-4.05, p < 0.001). Time-series analysis revealed consistently higher hypoglycemia risk in the RYGB group, with hazard ratios ranging from 5.37 (95% CI 4.09-7.03) at 1 week to 3.75 (95% CI 3.45-4.06) at 10 years post-surgery (all p < 0.001). Subgroup analysis of RYGB patients who developed hypoglycemia showed a 30-day hospitalization rate of 21.3% and a mortality rate of 0.71%.
RYGB surgery is associated with a significantly increased risk of hypoglycemia in patients with obesity and without diabetes, both in the short-term and long-term follow-up. These findings underscore the importance of monitoring and managing hypoglycemia in patients undergoing RYGB surgery, even in the absence of preexisting diabetes.
Roux-en-Y胃旁路术（RYGB）是治疗肥胖症的一种有效方法。然而，非糖尿病患者术后低血糖的发生率及长期风险尚不清楚。本研究旨在调查肥胖且无糖尿病患者接受RYGB手术后低血糖的患病率。
使用TriNetX数据库进行一项回顾性队列研究。研究人群包括15,085例接受RYGB手术的肥胖患者（BMI≥30kg/m²）和3,200,074例非手术对照者，所有患者均无糖尿病病史或未使用过胰高血糖素样肽-1（GLP-1）受体激动剂。采用倾向评分匹配法平衡基线特征。主要结局为低血糖发生率，根据国际疾病分类第十版临床修订本（ICD-10-CM）编码或实验室值（血糖≤70mg/dL）定义。采用Cox回归分析计算风险比（HR）和95%置信区间（CI）。
在整个研究人群中，RYGB组低血糖风险（18.70%，n = 2,810）显著高于对照组（3.80%，n = 120,923；HR 4.3，95%CI 4.14 - 4.46，p < 0.001）。倾向评分匹配后（每组n = 14,916），与匹配对照组（5.0%，n = 749；HR 3.7，95%CI 3.44 - 4.05，p < 0.001）相比，RYGB患者的风险仍然较高。时间序列分析显示，RYGB组低血糖风险始终较高，术后1周时风险比为5.37（95%CI 4.09 - 7.03），术后10年时为3.75（95%CI 3.45 - 4.06）（所有p < 0.001）。对发生低血糖的RYGB患者进行亚组分析显示，30天住院率为21.3%，死亡率为0.71%。
RYGB手术在短期和长期随访中均与肥胖且无糖尿病患者低血糖风险显著增加相关。这些发现强调了对接受RYGB手术患者进行低血糖监测和管理的重要性，即使患者术前无糖尿病。
