Roux-en-Y Gastric Bypass Increases Glycemic Variability and Time in Hypoglycemia in Patients With Obesity and Prediabetes or Type 2 Diabetes: A Prospective Cohort Study

I Ilesanmi; G Tharakan; K Alexiadou; P Behary; H Alessimii; C Bovill-Taylor; J Kenkre; S Choudhury; C Doyle; S Purkayastha; A Miras; C Tsironis; H Chahal; SR Bloom; NS Oliver; AR Ahmed; B Khoo; TM-M Tan

doi:10.2337/dc20-1609

Roux-en-Y Gastric Bypass Increases Glycemic Variability and Time in Hypoglycemia in Patients With Obesity and Prediabetes or Type 2 Diabetes: A Prospective Cohort Study

I Ilesanmi, G Tharakan, K Alexiadou, P Behary, H Alessimii, C Bovill-Taylor, J Kenkre, S Choudhury, C Doyle, S Purkayastha, A Miras, C Tsironis, H Chahal, SR Bloom, NS Oliver, AR Ahmed, B Khoo, TM-M Tan

Research output: Contribution to journal › Article › peer-review

21 Citations (Scopus)

Abstract

OBJECTIVE

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.

RESEARCH DESIGN AND METHODS

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.

RESULTS

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.

CONCLUSIONS

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.

Original language	English
Pages (from-to)	614-617
Number of pages	4
Journal	Diabetes Care
Volume	44
Issue number	2
Early online date	17 Dec 2020
DOIs	https://doi.org/10.2337/dc20-1609
Publication status	Published (in print/issue) - 1 Feb 2021

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10.2337/dc20-1609

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Ilesanmi, I., Tharakan, G., Alexiadou, K., Behary, P., Alessimii, H., Bovill-Taylor, C., Kenkre, J., Choudhury, S., Doyle, C., Purkayastha, S., Miras, A., Tsironis, C., Chahal, H., Bloom, SR., Oliver, NS., Ahmed, AR., Khoo, B., & Tan, TM.-M. (2021). Roux-en-Y Gastric Bypass Increases Glycemic Variability and Time in Hypoglycemia in Patients With Obesity and Prediabetes or Type 2 Diabetes: A Prospective Cohort Study. Diabetes Care, 44(2), 614-617. https://doi.org/10.2337/dc20-1609

@article{913f813c186f46f0bfb6d375d825b17e,

title = "Roux-en-Y Gastric Bypass Increases Glycemic Variability and Time in Hypoglycemia in Patients With Obesity and Prediabetes or Type 2 Diabetes: A Prospective Cohort Study",

abstract = "OBJECTIVERoux-en-Y gastric bypass (RYGB) is an established treatment for type 2 diabetes and obesity. The study objective was to establish RYGB{\textquoteright}s effects on glycemic variability (GV) and hypoglycemia. RESEARCH DESIGN AND METHODSThis 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. RESULTSAfter 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. CONCLUSIONSPatients 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.",

author = "I Ilesanmi and G Tharakan and K Alexiadou and P Behary and H Alessimii and C Bovill-Taylor and J Kenkre and S Choudhury and C Doyle and S Purkayastha and A Miras and C Tsironis and H Chahal and SR Bloom and NS Oliver and AR Ahmed and B Khoo and TM-M Tan",

year = "2021",

month = feb,

day = "1",

doi = "10.2337/dc20-1609",

language = "English",

volume = "44",

pages = "614--617",

journal = "Diabetes Care",

issn = "0149-5992",

publisher = "American Diabetes Association ",

number = "2",

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Ilesanmi, I, Tharakan, G, Alexiadou, K, Behary, P, Alessimii, H, Bovill-Taylor, C, Kenkre, J, Choudhury, S, Doyle, C, Purkayastha, S, Miras, A, Tsironis, C, Chahal, H, Bloom, SR, Oliver, NS, Ahmed, AR, Khoo, B & Tan, TM-M 2021, 'Roux-en-Y Gastric Bypass Increases Glycemic Variability and Time in Hypoglycemia in Patients With Obesity and Prediabetes or Type 2 Diabetes: A Prospective Cohort Study', Diabetes Care, vol. 44, no. 2, pp. 614-617. https://doi.org/10.2337/dc20-1609

TY - JOUR

T1 - Roux-en-Y Gastric Bypass Increases Glycemic Variability and Time in Hypoglycemia in Patients With Obesity and Prediabetes or Type 2 Diabetes: A Prospective Cohort Study

AU - Ilesanmi, I

AU - Tharakan, G

AU - Alexiadou, K

AU - Behary, P

AU - Alessimii, H

AU - Bovill-Taylor, C

AU - Kenkre, J

AU - Choudhury, S

AU - Doyle, C

AU - Purkayastha, S

AU - Miras, A

AU - Tsironis, C

AU - Chahal, H

AU - Bloom, SR

AU - Oliver, NS

AU - Ahmed, AR

AU - Khoo, B

AU - Tan, TM-M

PY - 2021/2/1

Y1 - 2021/2/1

N2 - OBJECTIVERoux-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. RESEARCH DESIGN AND METHODSThis 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. RESULTSAfter 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. CONCLUSIONSPatients 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.

AB - OBJECTIVERoux-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. RESEARCH DESIGN AND METHODSThis 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. RESULTSAfter 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. CONCLUSIONSPatients 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.

UR - https://pubmed.ncbi.nlm.nih.gov/33334806/

UR - https://www.scopus.com/pages/publications/85100280215

U2 - 10.2337/dc20-1609

DO - 10.2337/dc20-1609

M3 - Article

C2 - 33334806

SN - 0149-5992

VL - 44

SP - 614

EP - 617

JO - Diabetes Care

JF - Diabetes Care

IS - 2

ER -

Roux-en-Y Gastric Bypass Increases Glycemic Variability and Time in Hypoglycemia in Patients With Obesity and Prediabetes or Type 2 Diabetes: A Prospective Cohort Study

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