المؤلفون: Schönenberger, Katja A.^1,2 (AUTHOR), Ferreira, Antonio¹ (AUTHOR), Stebler, Céline¹ (AUTHOR), Prendin, Francesco³ (AUTHOR), Gawinecka, Joanna⁴ (AUTHOR), Nakas, Christos T.^5,6 (AUTHOR), Mühlebach, Stefan² (AUTHOR), Stanga, Zeno¹ (AUTHOR), Facchinetti, Andrea³ (AUTHOR), Herzig, David¹ (AUTHOR), Bally, Lia¹ (AUTHOR) lia.bally@insel.ch

المصدر: Diabetes, Obesity & Metabolism. Oct2023, Vol. 25 Issue 10, p2853-2861. 9p.

مصطلحات موضوعية: *INSULIN aspart, *CROSSOVER trials, *HYPOGLYCEMIA, *BLOOD sugar, *GLUCOSE, *GASTRIC bypass, *HYPERGLYCEMIA

مستخلص: Aim: To evaluate the efficacy of nutritional hypoglycaemia correction strategies in postbariatric hypoglycaemia (PBH) after Roux‐en‐Y gastric bypass (RYGB). Materials and methods: In a randomized, controlled, three‐arm crossover trial, eight post‐RYGB adults (mean [SD] 7.0 [1.4] years since surgery) with PBH ingested a solid mixed meal (584 kcal, 85 g carbohydrates, 21 g fat, 12 g protein) to induce hypoglycaemia on three separate days. Upon reaching plasma glucose of less than 3.0 mmol/L, hypoglycaemia was corrected with 15 g of glucose (G15), 5 g of glucose (G5) or a protein bar (P10, 10 g of protein) in random order. The primary outcome was percentage of time spent in the target plasma glucose range (3.9‐5.5 mmol/L) during 40 minutes after correction. Results: Postcorrection time spent in the target glucose range did not differ significantly between the interventions (P =.161). However, postcorrection time with glucose less than 3.9 mmol/L was lower after G15 than P10 (P =.007), whereas time spent with glucose more than 5.5 mmol/L, peak glucose and insulin 15 minutes postcorrection were higher after G15 than G5 and P10 (P <.001). Glucagon 15 minutes postcorrection was higher after P10 than after G15 and G5 (P =.002 and P =.003, respectively). G15 resulted in rebound hypoglycaemia (< 3.0 mmol/L) in three of eight cases (38%), while no rebound hypoglycaemia occurred with G5 and P10. Conclusions: Correcting hypoglycaemia with 15 g of glucose should be reconsidered in post‐RYGB PBH. A lower dose appears to sufficiently increase glucose levels outside the critical range in most cases, and complementary nutrients (e.g. proteins) may provide glycaemia‐stabilizing benefits. Registration number of clinical trial: NTC05250271 (ClinicalTrials.gov). [ABSTRACT FROM AUTHOR]

المؤلفون: Tripyla, Afroditi, Ferreira, Antonio, Schönenberger, Katja A., Näf, Noah H., Inderbitzin, Lukas E., Prendin, Francesco, Cossu, Luca, Cappon, Giacomo, Facchinetti, Andrea, Herzig, David, Bally, Lia

المصدر: Diabetes Care; Oct2023, Vol. 46 Issue 10, p1792-1798, 7p

مصطلحات موضوعية: GASTRIC bypass, HYPOGLYCEMIA, SYMPTOMS, MORBID obesity, JUDGMENT (Psychology), HYPERGLYCEMIA

مستخلص: OBJECTIVE: Post–bariatric surgery hypoglycemia (PBH) is a metabolic complication of Roux-en-Y gastric bypass (RYGB). Since symptoms are a key component of the Whipple's triad to diagnose nondiabetic hypoglycemia, we evaluated the relationship between self-reported symptoms and postprandial sensor glucose profiles. RESEARCH DESIGN AND METHODS: Thirty patients with PBH after RYGB (age: 50.1 [41.6–60.6] years, 86.7% female, BMI: 26.5 [23.5–31.2] kg/m²; median [interquartile range]) wore a blinded Dexcom G6 sensor while recording autonomic, neuroglycopenic, and gastrointestinal symptoms over 50 days. Symptoms (overall and each type) were categorized into those occurring in postprandial periods (PPPs) without hypoglycemia, or in the preceding dynamic or hypoglycemic phase of PPPs with hypoglycemia (nadir sensor glucose <3.9 mmol/L). We further explored the relationship between symptoms and the maximum negative rate of sensor glucose change and nadir sensor glucose levels. RESULTS: In 5,851 PPPs, 775 symptoms were reported, of which 30.6 (0.0–59.9)% were perceived in PPPs without hypoglycemia, 16.7 (0.0–30.1)% in the preceding dynamic phase and 45.0 (13.7–84.7)% in the hypoglycemic phase of PPPs with hypoglycemia. Per symptom type, 53.6 (23.8–100.0)% of the autonomic, 30.0 (5.6–80.0)% of the neuroglycopenic, and 10.4 (0.0–50.0)% of the gastrointestinal symptoms occurred in the hypoglycemic phase of PPPs with hypoglycemia. Both faster glucose dynamics and lower nadir sensor glucose levels were related with symptom perception. CONCLUSIONS: The relationship between symptom perception and PBH is complex, challenging clinical judgement and decision-making in this population. [ABSTRACT FROM AUTHOR]

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المؤلفون: Ferreira, Antonio¹ (AUTHOR), Schönenberger, Katja A.^1,2 (AUTHOR), Potoczna, Natascha³ (AUTHOR), Vogt, Andreas⁴ (AUTHOR), Gerber, Philipp A.⁵ (AUTHOR), Zehetner, Jörg⁶ (AUTHOR), Giachino, Daniel⁷ (AUTHOR), Nett, Philipp⁸ (AUTHOR), Gawinecka, Joanna⁹ (AUTHOR), Cossu, Luca¹⁰ (AUTHOR), Fuster, Daniel G.¹¹ (AUTHOR), Dalla Man, Chiara¹⁰ (AUTHOR), Facchinetti, Andrea¹⁰ (AUTHOR), Melmer, Andreas¹ (AUTHOR), Nakas, Christos T.^12,13 (AUTHOR), Hepprich, Matthias¹⁴ (AUTHOR), Donath, Marc Y.¹⁴ (AUTHOR), Herzig, David¹ (AUTHOR), Bally, Lia¹ (AUTHOR) lia.bally@insel.ch

المصدر: Diabetes Technology & Therapeutics. Jul2023, Vol. 25 Issue 7, p467-475. 9p.

مصطلحات موضوعية: *GASTRIC bypass, *CROSSOVER trials, *HYPOGLYCEMIA, *BLOOD sugar, *EMPAGLIFLOZIN

مستخلص: Aims: To investigate the effect of empagliflozin on glucose dynamics in individuals suffering from postbariatric hypoglycemia (PBH) after Roux-en-Y gastric bypass (RYGB). Methods: Twenty-two adults with PBH after RYGB were randomized to empagliflozin 25 mg or placebo once daily over 20 days in a randomized, double-blind, placebo-controlled, crossover trial. The primary efficacy outcome was the amplitude of plasma glucose excursion (peak to nadir) during a mixed-meal tolerance test (MMTT). Outcomes of the outpatient period were assessed using continuous glucose monitoring (CGM) and an event-tracking app. Results: The amplitude of glucose excursion during the MMTT was 8.1 ± 2.4 mmol/L with empagliflozin versus 8.1 ± 2.6 mmol/L with placebo (mean ± standard deviation, P = 0.807). CGM-based mean amplitude of glucose excursion during the 20-day period was lower with empagliflozin than placebo (4.8 ± 1.3 vs. 5.2 ± 1.6. P = 0.028). Empagliflozin reduced the time spent with CGM values >10.0 mmol/L (3.8 ± 3.5% vs. 4.7 ± 3.8%, P = 0.009), but not the time spent with CGM values <3.0 mmol/L (1.7 ± 1.6% vs. 1.5 ± 1.5%, P = 0.457). No significant difference was observed in the quantity and quality of recorded symptoms. Eleven adverse events occurred with empagliflozin (three drug-related) and six with placebo. Conclusions: Empagliflozin 25 mg reduces glucose excursions but not hypoglycemia in individuals with PBH. Clinical Trial Registration: Clinicaltrials.gov: NCT05057819 [ABSTRACT FROM AUTHOR]