TY - JOUR
T1 - Postbariatric hypoglycemia
T2 - symptom patterns and associated risk factors in the Longitudinal Assessment of Bariatric Surgery study
AU - LABS Investigators
AU - Fischer, Laura E.
AU - Wolfe, Bruce M.
AU - Fino, Nora
AU - Elman, Miriam R.
AU - Flum, David R.
AU - Mitchell, James E.
AU - Pomp, Alfons
AU - Pories, Walter J.
AU - Purnell, Jonathan Q.
AU - Patti, Mary Elizabeth
AU - Berk, Paul D.
AU - Bessler, Marc
AU - Daud, Amna
AU - Lobdell, Harrison
AU - Mwelu, Jemela
AU - Schrope, Beth
AU - Ude, Akuezunkpa
AU - Honohan, Jamie
AU - Capasso, Michelle
AU - Costa, Ricardo
AU - Dakin, Greg
AU - Ebel, Faith
AU - Gagner, Michel
AU - Hsieh, Jane
AU - Strain, Gladys
AU - Bowden, Rita
AU - Chapman, William
AU - Cundiff, Blair
AU - Ball, Mallory
AU - Cunningham, Emily
AU - Dohm, Lynis
AU - Pender, John
AU - Pories, Walter
AU - Barker, Jennifer
AU - Howell, Michael
AU - Garcia, Luis
AU - Lancaster, Kathy
AU - Lovaas, Erika
AU - Monson, Tim
AU - Cassady, Chelsea
AU - Coburn, Emily
AU - Moher, Emily
AU - Deveney, Clifford
AU - Elder, Katherine
AU - Greene, Stefanie
AU - Purnell, Jonathan
AU - O'Rourke, Robert
AU - Sorenson, Chad
AU - Patterson, Emma
AU - Raum, William
N1 - Publisher Copyright:
© 2021
PY - 2021/10
Y1 - 2021/10
N2 - Background: Postbariatric hypoglycemia (PBH) can be a devastating complication for which current therapies are often incompletely effective. More information is needed regarding frequency, incidence, and risk factors for PBH. Objectives: To examine hypoglycemia symptoms following Roux-en-Y gastric bypass (RYGB) and laparoscopic adjustable gastric banding (LAGB) and baseline and in-study risk factors. Setting: Multicenter, at 10 US hospitals in 6 geographically diverse clinical centers. Methods: A prospective, longitudinal cohort study of adults undergoing RYGB or LAGB as part of clinical care between 2006 and 2009 were recruited and followed until January 31, 2015, with baseline and annual postoperative research assessments. We analyzed baseline prevalence and post-operative incidence and frequency of self-reported hypoglycemia symptoms as well as potential preoperative risk factors. Results: In all groups, postoperative prevalence of hypoglycemia symptoms was 38.5%. Symptom prevalence increased postoperatively from 2.8%–36.4% after RYGB in patients without preoperative diabetes (T2D), with similar patterns in prediabetes (4.9%–29.1%). Individuals with T2D had higher baseline hypoglycemia symptoms (28.9%), increasing after RYGB (57.9%). Hypoglycemia symptoms were lower after LAGB, with 39.1% reported hypoglycemia symptoms at only 1 postoperative visit with few (4.0%) having persistent symptoms at 6 or more annual visits. Timing of symptoms was not restricted to the postprandial state. Symptoms of severe hypoglycemia were reported in 2.6–3.6% after RYGB. The dominant risk factor for postoperative symptoms was preoperative symptoms; additionally, baseline selective serotonin (SSRI) and serotonin-norepinephrine (SNRI) reuptake inhibitor use was also associated with increased risk in multivariable analysis. Weight loss and regain were not related to hypoglycemia symptom reporting. Conclusion: Hypoglycemia symptoms increase over time after RYGB, particularly in patients without diabetes. In a small percentage, symptoms can be persistent or severe and require hospitalization. Preoperative hypoglycemia symptoms and SSRI/SNRI use in RYGB patients without diabetes is associated with increased risk of symptoms.
AB - Background: Postbariatric hypoglycemia (PBH) can be a devastating complication for which current therapies are often incompletely effective. More information is needed regarding frequency, incidence, and risk factors for PBH. Objectives: To examine hypoglycemia symptoms following Roux-en-Y gastric bypass (RYGB) and laparoscopic adjustable gastric banding (LAGB) and baseline and in-study risk factors. Setting: Multicenter, at 10 US hospitals in 6 geographically diverse clinical centers. Methods: A prospective, longitudinal cohort study of adults undergoing RYGB or LAGB as part of clinical care between 2006 and 2009 were recruited and followed until January 31, 2015, with baseline and annual postoperative research assessments. We analyzed baseline prevalence and post-operative incidence and frequency of self-reported hypoglycemia symptoms as well as potential preoperative risk factors. Results: In all groups, postoperative prevalence of hypoglycemia symptoms was 38.5%. Symptom prevalence increased postoperatively from 2.8%–36.4% after RYGB in patients without preoperative diabetes (T2D), with similar patterns in prediabetes (4.9%–29.1%). Individuals with T2D had higher baseline hypoglycemia symptoms (28.9%), increasing after RYGB (57.9%). Hypoglycemia symptoms were lower after LAGB, with 39.1% reported hypoglycemia symptoms at only 1 postoperative visit with few (4.0%) having persistent symptoms at 6 or more annual visits. Timing of symptoms was not restricted to the postprandial state. Symptoms of severe hypoglycemia were reported in 2.6–3.6% after RYGB. The dominant risk factor for postoperative symptoms was preoperative symptoms; additionally, baseline selective serotonin (SSRI) and serotonin-norepinephrine (SNRI) reuptake inhibitor use was also associated with increased risk in multivariable analysis. Weight loss and regain were not related to hypoglycemia symptom reporting. Conclusion: Hypoglycemia symptoms increase over time after RYGB, particularly in patients without diabetes. In a small percentage, symptoms can be persistent or severe and require hospitalization. Preoperative hypoglycemia symptoms and SSRI/SNRI use in RYGB patients without diabetes is associated with increased risk of symptoms.
KW - Bariatric surgery
KW - Diabetes
KW - Hypoglycemia
KW - Laparoscopic adjustable gastric band
KW - Roux-en-Y gastric bypass
KW - SNRI
KW - SSRI
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UR - http://www.scopus.com/inward/citedby.url?scp=85110606244&partnerID=8YFLogxK
U2 - 10.1016/j.soard.2021.04.021
DO - 10.1016/j.soard.2021.04.021
M3 - Article
C2 - 34294589
AN - SCOPUS:85110606244
SN - 1550-7289
VL - 17
SP - 1787
EP - 1798
JO - Surgery for Obesity and Related Diseases
JF - Surgery for Obesity and Related Diseases
IS - 10
ER -