PMID- 30315341
OWN - NLM
STAT- MEDLINE
DCOM- 20190605
LR  - 20190605
IS  - 1432-0428 (Electronic)
IS  - 0012-186X (Linking)
VI  - 62
IP  - 1
DP  - 2019 Jan
TI  - Postprandial hypoglycaemia after Roux-en-Y gastric bypass in individuals with 
      type 2 diabetes.
PG  - 178-186
LID - 10.1007/s00125-018-4737-5 [doi]
AB  - AIMS/HYPOTHESIS: Postprandial hypoglycaemia (PPHG) is a complication of Roux-en-Y 
      gastric bypass (RYGB) surgery in normoglycaemic individuals. In type 2 diabetes, 
      RYGB improves glucose metabolism, but whether this improvement is related to the 
      later development of PPHG is not known. We investigated the presence and 
      mechanisms of PPHG in individuals with type 2 diabetes undergoing RYGB. METHODS: 
      A total of 35 obese individuals with type 2 diabetes underwent an OGTT before and 
      24 months after surgery. PPHG was defined as a plasma glucose level of 
      </=3.3 mmol/l when not taking glucose-lowering agents. Insulin sensitivity was 
      assessed by oral glucose insulin sensitivity index and beta-cell function by 
      mathematical modelling of the plasma glucose, insulin and C-peptide 
      concentrations. RESULTS: After surgery, PPHG occurred in 11 of 35 individuals who 
      underwent RYGB. Before surgery, BMI was lower, glycaemic control less good and 
      time of glucose peak earlier in the PPHG vs No PPHG group, and the duration of 
      diabetes was shorter with PPHG (all p </= 0.05). In addition, insulin sensitivity 
      was greater in the PPHG than No PPHG group (p = 0.03). After surgery, BMI and 
      fasting glucose and insulin levels decreased similarly in the two groups; insulin 
      secretion during the first hour of the OGTT increased more in the PPHG than No 
      PPHG group (p = 0.04). Beta-cell glucose sensitivity increased more in 
      individuals with PPHG than those without (p = 0.002). Over the same time 
      interval, the glucagon-like peptide 1 (GLP-1) response was lower in individuals 
      with PPHG before surgery (p = 0.05), and increased more after surgery. At 2 h 
      after glucose ingestion in the OGTT, postsurgery plasma glucagon level was 
      significantly lower in the PPHG than No PPHG group. CONCLUSIONS/INTERPRETATION: 
      In morbidly obese individuals with type 2 diabetes, spontaneous PPHG may occur 
      after bariatric surgery independently of a remission of diabetes. Before surgery, 
      individuals had a shorter duration and were more insulin sensitive. Two years 
      after surgery, these individuals developed greater beta-cell glucose sensitivity, 
      and showed greater insulin and GLP-1 release early in the OGTT.
FAU - Guarino, Daniela
AU  - Guarino D
AD  - Department of Clinical and Experimental Medicine, University of Pisa, Via Savi 
      10, 56126, Pisa, Italy.
AD  - CNR Institute of Clinical Physiology, Pisa, Italy.
FAU - Moriconi, Diego
AU  - Moriconi D
AD  - Department of Clinical and Experimental Medicine, University of Pisa, Via Savi 
      10, 56126, Pisa, Italy.
FAU - Mari, Andrea
AU  - Mari A
AD  - CNR Institute of Neurosciences, Padua, Italy.
FAU - Rebelos, Eleni
AU  - Rebelos E
AD  - Department of Clinical and Experimental Medicine, University of Pisa, Via Savi 
      10, 56126, Pisa, Italy.
FAU - Colligiani, Daria
AU  - Colligiani D
AD  - Department of Clinical and Experimental Medicine, University of Pisa, Via Savi 
      10, 56126, Pisa, Italy.
FAU - Baldi, Simona
AU  - Baldi S
AD  - Department of Clinical and Experimental Medicine, University of Pisa, Via Savi 
      10, 56126, Pisa, Italy.
FAU - Anselmino, Marco
AU  - Anselmino M
AD  - Bariatric Surgery Unit, Santa Chiara Hospital, Pisa, Italy.
FAU - Ferrannini, Ele
AU  - Ferrannini E
AD  - CNR Institute of Clinical Physiology, Pisa, Italy.
FAU - Nannipieri, Monica
AU  - Nannipieri M
AUID- ORCID: 0000-0003-1346-2813
AD  - Department of Clinical and Experimental Medicine, University of Pisa, Via Savi 
      10, 56126, Pisa, Italy. monica.nannipieri@dmi.unipi.it.
LA  - eng
PT  - Clinical Trial
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
DEP - 20181012
PL  - Germany
TA  - Diabetologia
JT  - Diabetologia
JID - 0006777
RN  - 0 (C-Peptide)
SB  - IM
MH  - C-Peptide/blood
MH  - Diabetes Mellitus, Type 2/*blood/*surgery
MH  - Female
MH  - *Gastric Bypass
MH  - Glucose Tolerance Test
MH  - Humans
MH  - Hypoglycemia/blood/surgery
MH  - Male
MH  - Obesity, Morbid/blood/surgery
OTO - NOTNLM
OT  - Beta-cell glucose sensitivity
OT  - GLP-1
OT  - Glucagon
OT  - Insulin sensitivity
OT  - Reactive hypoglycaemia
OT  - Roux-en-Y gastric bypass
OT  - Type 2 diabetes mellitus
EDAT- 2018/10/14 06:00
MHDA- 2019/06/06 06:00
CRDT- 2018/10/14 06:00
PHST- 2018/04/10 00:00 [received]
PHST- 2018/08/09 00:00 [accepted]
PHST- 2018/10/14 06:00 [pubmed]
PHST- 2019/06/06 06:00 [medline]
PHST- 2018/10/14 06:00 [entrez]
AID - 10.1007/s00125-018-4737-5 [pii]
AID - 10.1007/s00125-018-4737-5 [doi]
PST - ppublish
SO  - Diabetologia. 2019 Jan;62(1):178-186. doi: 10.1007/s00125-018-4737-5. Epub 2018 
      Oct 12.