Glycemic patterns are distinct in individuals with post-bariatric hypoglycemia after gastric bypass (PBH-RYGB)
Cite this dataset
Patti, Mary Elizabeth (2022). Glycemic patterns are distinct in individuals with post-bariatric hypoglycemia after gastric bypass (PBH-RYGB) [Dataset]. Dryad. https://doi.org/10.5061/dryad.kprr4xh4b
While bariatric surgery can improve glycemia in type 2 diabetes (T2D), it can also result in severe hypoglycemia with neuroglycopenia, termed post-bariatric hypoglycemia (PBH). Hypoglycemia typically occurs postprandially but is also reported post-activity or mid-nocturnally.
We used masked CGM (Dexcom G4) to quantify glycemia, glycemic variability (GV), and severity/length of low sensor glucose (SG) values in patients with PBH with prior Roux-en-Y gastric bypass (PBH-RYGB, n=40), and compared patterns to those from individuals with reactive hypoglycemia without GI surgery (Non-Surg Hypo, n=20) and to public data from healthy controls (HC, n=38) and individuals with pre-diabetes (Pre-DM, n=14), and newly-diagnosed T2D (n=5). Data were assessed over 24 hours, daytime (6 AM to midnight) and nighttime (midnight to 6 AM).
Mean and median SG were similar for PBH-RYGB and HC (mean: 99.8±18.6 vs. 96.9±10.2 mg/dL; median: 93.0±14.8 vs. 94.5±7.4 mg/dL). By contrast, PBH-RYGB had a higher coefficient of variation (27.3±6.8 vs. 17.9±2.4%, p<0.0001) and wider range (154.5±50.4 vs. 112.0±26.7 mg/dL, p<0.0001). Nadir was lowest in PBH-RYGB (42.5±3.7 vs. HC 49.0±11.9 mg/dL, p=0.0046), with >2-fold greater time with SG<70 mg/dL vs. HC (7.7±8.4 vs. 3.2±4.1%, p=0.0013); these differences were even greater at night (12.6±16.9 vs. 1.0±1.5%, p<0.0001). Non-Surg Hypo also had 4-fold greater time with SG<70 at night vs. HC (SG <70: 4.0 ± 5.9% vs 1.0 ± 1.5%), but glycemic variability was not increased in this group.
Patients with PBH-RYGB experience higher glycemic variability and frequency of SG<70 compared to HC, especially at night. These data suggest that additional pathophysiologic mechanisms beyond prandial changes contribute to PBH.
Supplementary Tables provide more information about demographics of the participants.
Joslin Diabetes Center