PMID- 37445330
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20230718
IS  - 2077-0383 (Print)
IS  - 2077-0383 (Electronic)
IS  - 2077-0383 (Linking)
VI  - 12
IP  - 13
DP  - 2023 Jun 27
TI  - Mixed Meal Tolerance Test Versus Continuous Glucose Monitoring for an Effective 
      Diagnosis of Persistent Post-Bariatric Hypoglycemia.
LID - 10.3390/jcm12134295 [doi]
LID - 4295
AB  - Gastric bypass determines an increase in incretin secretion and glucose 
      excursions throughout the day and may sometimes entail the development of severe 
      post-bariatric hypoglycemia (PBH). However, there is no consensus on the gold 
      standard method for its diagnosis. In this study, we evaluated the usefulness of 
      a mixed meal tolerance test (MMTT) and continuous glucose monitoring (CGM) for 
      the diagnosis of PBH, defined as glucose levels <54 mg/dL (3.0 mmol/L). We found 
      that hypoglycemia occurred in 60% of patients after the MMTT and in 75% during 
      CGM, and it was predominantly asymptomatic. The MMTT confirmed the diagnosis of 
      PBH in 88.9%of patients in whom surgery had been performed more than three years 
      ago, in comparison to 36.4% in cases with a shorter postsurgical duration. CGM 
      diagnosed nocturnal asymptomatic hypoglycemia in 70% of patients, and daytime 
      postprandial hypoglycemia in 25% of cases. The mean duration of asymptomatic 
      hypoglycemia was more than 30 min a day. Patients with >/=2% of their CGM readings 
      with hypoglycemia exhibited a higher degree of glucose variability than those 
      with <1% of the time in hypoglycemia. Our results show that the MMTT may be a 
      useful dynamic test to confirm the occurrence of hypoglycemia in a large number 
      of patients with persistent and recurrent PBH during long-term follow-up after 
      gastric bypass. CGM, on its part, helps identify hypoglycemia in the real-world 
      setting, especially nocturnal asymptomatic hypoglycemia, bringing to light that 
      PBH is not always postprandial.
FAU - Ramos-Levi, Ana M
AU  - Ramos-Levi AM
AUID- ORCID: 0000-0002-8824-9200
AD  - Departament of Endocrinology and Nutrition, Hospital La Princesa, Instituto de 
      Investigacion Princesa, Universidad Autonoma de Madrid, 28049 Madrid, Spain.
FAU - Rubio-Herrera, Miguel A
AU  - Rubio-Herrera MA
AUID- ORCID: 0000-0002-0495-6240
AD  - Departament of Endocrinology and Nutrition, Hospital Clinico San Carlos, IdISSC, 
      28040 Madrid, Spain.
AD  - Faculty of Medicine, Department of Medicine, Universidad Complutense, 28040 
      Madrid, Spain.
FAU - Matia-Martin, Pilar
AU  - Matia-Martin P
AUID- ORCID: 0000-0001-9844-3755
AD  - Departament of Endocrinology and Nutrition, Hospital Clinico San Carlos, IdISSC, 
      28040 Madrid, Spain.
AD  - Faculty of Medicine, Department of Medicine, Universidad Complutense, 28040 
      Madrid, Spain.
FAU - Perez-Ferre, Natalia
AU  - Perez-Ferre N
AUID- ORCID: 0000-0002-0590-5365
AD  - Departament of Endocrinology and Nutrition, Hospital Clinico San Carlos, IdISSC, 
      28040 Madrid, Spain.
AD  - Faculty of Medicine, Department of Medicine, Universidad Complutense, 28040 
      Madrid, Spain.
FAU - Marcuello, Clara
AU  - Marcuello C
AD  - Departament of Endocrinology and Nutrition, Hospital Clinico San Carlos, IdISSC, 
      28040 Madrid, Spain.
FAU - Sanchez-Pernaute, Andres
AU  - Sanchez-Pernaute A
AD  - Department of Surgery, Hospital Clinico San Carlos, IdISSC, Faculty of Medicine, 
      Universidad Complutense, 28040 Madrid, Spain.
FAU - Torres-Garcia, Antonio J
AU  - Torres-Garcia AJ
AD  - Department of Surgery, Hospital Clinico San Carlos, IdISSC, Faculty of Medicine, 
      Universidad Complutense, 28040 Madrid, Spain.
FAU - Calle-Pascual, Alfonso L
AU  - Calle-Pascual AL
AUID- ORCID: 0000-0002-3628-9323
AD  - Departament of Endocrinology and Nutrition, Hospital Clinico San Carlos, IdISSC, 
      28040 Madrid, Spain.
AD  - Faculty of Medicine, Department of Medicine, Universidad Complutense, 28040 
      Madrid, Spain.
AD  - Centro de Investigacion Biomedica en Red de Diabetes y Enfermedades Metabolicas 
      Asociadas (CIBERDEM), 28040 Madrid, Spain.
LA  - eng
PT  - Journal Article
DEP - 20230627
PL  - Switzerland
TA  - J Clin Med
JT  - Journal of clinical medicine
JID - 101606588
PMC - PMC10342744
OTO - NOTNLM
OT  - continuous glucose monitoring
OT  - gastric bypass
OT  - mixed meal tolerance test
OT  - post-bariatric hypoglycemia
COIS- The authors declare no conflict of interest.
EDAT- 2023/07/14 13:06
MHDA- 2023/07/14 13:07
PMCR- 2023/06/27
CRDT- 2023/07/14 01:10
PHST- 2023/04/30 00:00 [received]
PHST- 2023/05/31 00:00 [revised]
PHST- 2023/06/24 00:00 [accepted]
PHST- 2023/07/14 13:07 [medline]
PHST- 2023/07/14 13:06 [pubmed]
PHST- 2023/07/14 01:10 [entrez]
PHST- 2023/06/27 00:00 [pmc-release]
AID - jcm12134295 [pii]
AID - jcm-12-04295 [pii]
AID - 10.3390/jcm12134295 [doi]
PST - epublish
SO  - J Clin Med. 2023 Jun 27;12(13):4295. doi: 10.3390/jcm12134295.