Counter-regulatory responses to postprandial hypoglycaemia in patients with post-bariatric hypoglycaemia vs surgical and non-surgical control individuals
Authors' conclusion
The glucagon response to insulin-induced postprandial hypoglycaemia is lower in post-bariatric surgery individuals compared with non-surgical control individuals, irrespective of the surgical modality. No significant differences were found between patients with post-bariatric hypoglycaemia and surgical control individuals, suggesting that impaired counter-regulation is not a root cause of post-bariatric hypoglycaemia.
Study context
- Population
- Adults with comparable age, sex and BMI; postprandial hypoglycaemic clamp to 2.5 mmol/l 150–170 min after 15 g oral glucose4 groups
- Participants
- 32 adults
- Comparison
- Post-bariatric hypoglycaemia vs RYGB, SG and non-surgical controls
- Outcome
- Incremental AUC of glucagon during hypoglycaemia
Methodological detailspostprandial hypoglycaemic clamp, dual-tracer approach, Clinical research unit
- Postprandial hypoglycaemic clamp
- Dual-tracer approach
- Clinical research unit
Main finding
As reported in the abstract
Glucagon exposure during hypoglycaemia
- Glucagon exposure significantly lower in all surgical groups vs non-surgical controls
- Post-bariatric hypoglycaemia vs Non-surgical control: all p<0.01
- RYGB vs Non-surgical control: all p<0.01
- SG vs Non-surgical control: all p<0.01
Observational data: associations, not effects.
Further findings
Median, pmol/l
| Outcome | Post-bariatric hypoglycaemia | Non-surgical control | P value |
|---|---|---|---|
| Pancreatic polypeptide during hypoglycaemiaPost-bariatric hypoglycaemia vs Non-surgical control · lower with post-bariatric hypoglycaemia | 24.7 (IQR 10.9–38.7) | 238.7 (IQR 186.3–288.9) | P = 0.005 |
Glucose fluxes, early postprandial period
- Rate of oral glucose appearance, total glucose appearance and glucose disappearance higher in both RYGB groups vs non-surgical controls (all p<0.05)
Other hormonal responses and endogenous glucose production during hypoglycaemia
- Did not significantly differ between the groups
Original publication
Counter-regulatory responses to postprandial hypoglycaemia in patients with post-bariatric hypoglycaemia vs surgical and non-surgical control individuals. Diabetologia. Published 17 January 2023. doi:10.
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