Postbariatric hypoglycemia in symptomatic versus asymptomatic patients: proposals for clinical assessments

INTRODUCTION: Recurrent hypoglycemia due to postbariatric hypoglycemia (PBH) is a postoperative complication after Roux-en-Y gastric bypass (RYGBP). The historic term is late dumping syndrome or reactive hypoglycemia. The aim of this study was to assess clinically applicable tools, in order to diagnose these patients, for the purpose of preventing hypoglycemic complications. RESEARCH DESIGN AND METHODS: Ten patients with PBS and nine controls were recruited. Continuous glucose monitoring (CGM) and food intake were registered for 7 days, together with metabolic parameters at baseline. RESULTS: There was a significant difference (p<0.05) in Dumping Syndrome Rating Scale (DSRS) between the groups. There was no difference between p-glucose or HbA1c between the groups, but a highly significant difference in C peptide p<0.01 was observed. Using the Dexcom Studio system, the PBH group had significantly (p<0.05) more time during the day in very low blood sugar (5.9±4.2% vs 1.8%±2.3%) compared with the controls. Counting hyperglycemic and hypoglycemic episodes showed that the quantity of hypoglycemic episodes was significantly higher, p<0.01, in the PBH group compared with controls (16.6±11.0 vs 8.1±8.6 hypoglycemic events). C peptide was positively correlated with the late dumping group, p<0.01 (CI 95% 0.353 to 0.814) and very low blood sugar (<3.2 mmol/L) in all subjects with p<0.01 (CI 95% 0.194 to 0.763). CONCLUSIONS: Finding patients with recurrent hypoglycemic episodes after bariatric surgery is important to prevent future health problems. To diagnose recurrent hypoglycemia (PBH) after RYGBP, we used blood sugar analyzing tools that are commonly available in clinical settings. Interestingly, patients with few or no symptoms of PHB still had recurrent hyperglycemic and hypoglycemic events. We recommend an active approach with dumping syndrome questionnaires, assessment of metabolic parameters and CGM with food registration. Assessment of PBH using this method can potentially lead to reduced blood glucose variability due to behavioral changes.