Turk Nicole, Ramanujan Suruchi, Shamloo Termeh, Craig Colleen, McLaughlin Tracey
Department of Medicine, Stanford University School of Medicine, Stanford, CA 94305, USA.
J Endocr Soc. 2025 Jun 18;9(9):bvaf106. doi: 10.1210/jendso/bvaf106. eCollection 2025 Sep.
Postbariatric hypoglycemia (PBH), complicating up to one-third of bariatric surgeries, is characterized by repeated episodes of severe hypoglycemia and hypoglycemia unawareness that threaten patient safety and impair quality of life.
We tested the hypothesis that use of a continuous glucose monitor (CGM) would reduce hypoglycemia and improve quality of life in patients with PBH.
In a crossover design, 14 patients with diagnosed PBH were assigned in random order to sequential treatment with unblinded CGM or blinded CGM/no alarms for 10 days each. Glucose and quality of life measures were compared between the 2 periods.
Outpatient.
Hypoglycemia measured by fingerstick blood glucose in response to symptoms or CGM alarm and CGM glucose values; quality of life measures included dietary liberalization and hypoglycemia-related worries/behaviors captured by the Hypoglycemia Fear Survey-II.
Baseline frequency of hypoglycemic events, disability, and hypoglycemia-related worries were high. Symptom-triggered hypoglycemic events confirmed by fingerstick glucose were reduced 6-fold ( = .008) and the glucose nadir measured by CGM was >8 mg/dL higher ( = .005) during unblinded use of CGM compared to the blinded comparison period. Hypoglycemia Fear Survey-II scores improved significantly in response to unblinded CGM use compared to the blinded control period ( = .026). The intake of carbohydrate-containing meals increased without increasing rate of postprandial hyper- or hypoglycemia.
Use of unblinded CGM in patients with PBH reduces frequency and severity of hypoglycemia and improves quality of life by decreasing hypoglycemia-related worries and enabling a less restrictive diet. CGM should be considered a first-line treatment for patients with PBH.
减重术后低血糖（PBH）是减重手术常见的并发症，发生率高达三分之一，其特征为反复发生的严重低血糖和低血糖无意识症，这不仅威胁患者安全，还会损害生活质量。
我们检验了以下假设，即使用连续血糖监测仪（CGM）可减少PBH患者的低血糖发作，并改善其生活质量。
采用交叉设计，将14例确诊为PBH的患者随机依次接受为期10天的非盲法CGM治疗或盲法CGM/无警报治疗。比较两个阶段的血糖和生活质量指标。
门诊。
通过指尖血糖检测低血糖症状或CGM警报以及CGM血糖值来评估低血糖情况；生活质量指标包括饮食放宽情况以及通过低血糖恐惧调查-II捕获的与低血糖相关的担忧/行为。
低血糖事件、残疾和与低血糖相关的担忧的基线发生率较高。与盲法对照期相比，在非盲法使用CGM期间，通过指尖血糖确认的症状性低血糖事件减少了6倍（P = 0.008），CGM测量的血糖最低点高出>8 mg/dL（P = 0.005）。与盲法对照期相比，非盲法使用CGM后，低血糖恐惧调查-II评分显著改善（P = 0.026）。含碳水化合物餐的摄入量增加，而餐后高血糖或低血糖发生率未增加。
在PBH患者中使用非盲法CGM可降低低血糖的频率和严重程度，并通过减少与低血糖相关的担忧和允许限制较少的饮食来改善生活质量。CGM应被视为PBH患者的一线治疗方法。
