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Patients with neuroglycopenia after gastric bypass surgery have exaggerated incretin and insulin secretory responses to a mixed meal.
J Clin Endocrinol Metab. 2007 Dec; 92(12):4678-85.JC

Abstract

CONTEXT AND OBJECTIVE

Hyperinsulinemic hypoglycemia is newly recognized as a rare but important complication after Roux-en-Y gastric bypass (GB). The etiology of the syndrome and metabolic characteristics remain incompletely understood. Recent studies suggest that levels of incretin hormones are increased after GB and may promote excessive beta-cell function and/or growth.

PATIENTS AND METHODS

We performed a cross-sectional analysis of metabolic variables, in both the fasting state and after a liquid mixed-meal challenge, in four subject groups: 1) with clinically significant hypoglycemia [neuroglycopenia (NG)] after GB surgery, 2) with no symptoms of hypoglycemia at similar duration after GB surgery, 3) without GB similar to preoperative body mass index of the surgical cohorts, and 4) without GB similar to current body mass index of the surgical cohorts.

RESULTS

Insulin and C-peptide after the liquid mixed meal were both higher relative to the glucose level achieved in persons after GB with NG compared with asymptomatic individuals. Glucagon, glucagon-like peptide 1, and glucose-dependent insulinotropic peptide levels were higher in both post-GB surgical groups compared with both overweight and morbidly obese persons, and glucagon-like peptide 1 was markedly higher in the group with NG. Insulin resistance, assessed by homeostasis model assessment of insulin resistance, the composite insulin sensitivity index, or adiponectin, was similar in both post-GB groups. Dumping score was also higher in both GB groups but did not discriminate between asymptomatic and symptomatic patients. Notably, the frequency of asymptomatic hypoglycemia after a liquid mixed meal was high in post-GB patients.

CONCLUSION

A robust insulin secretory response was associated with postprandial hypoglycemia in patients after GB presenting with NG. Increased incretin levels may contribute to the increased insulin secretory response.

Authors+Show Affiliations

Joslin Diabetes Center, One Joslin Place, Boston, Massachusetts 02215, USA. allison.goldfine@joslin.harvard.eduNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

17895322

Citation

Goldfine, A B., et al. "Patients With Neuroglycopenia After Gastric Bypass Surgery Have Exaggerated Incretin and Insulin Secretory Responses to a Mixed Meal." The Journal of Clinical Endocrinology and Metabolism, vol. 92, no. 12, 2007, pp. 4678-85.
Goldfine AB, Mun EC, Devine E, et al. Patients with neuroglycopenia after gastric bypass surgery have exaggerated incretin and insulin secretory responses to a mixed meal. J Clin Endocrinol Metab. 2007;92(12):4678-85.
Goldfine, A. B., Mun, E. C., Devine, E., Bernier, R., Baz-Hecht, M., Jones, D. B., Schneider, B. E., Holst, J. J., & Patti, M. E. (2007). Patients with neuroglycopenia after gastric bypass surgery have exaggerated incretin and insulin secretory responses to a mixed meal. The Journal of Clinical Endocrinology and Metabolism, 92(12), 4678-85.
Goldfine AB, et al. Patients With Neuroglycopenia After Gastric Bypass Surgery Have Exaggerated Incretin and Insulin Secretory Responses to a Mixed Meal. J Clin Endocrinol Metab. 2007;92(12):4678-85. PubMed PMID: 17895322.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Patients with neuroglycopenia after gastric bypass surgery have exaggerated incretin and insulin secretory responses to a mixed meal. AU - Goldfine,A B, AU - Mun,E C, AU - Devine,E, AU - Bernier,R, AU - Baz-Hecht,M, AU - Jones,D B, AU - Schneider,B E, AU - Holst,J J, AU - Patti,M E, Y1 - 2007/09/25/ PY - 2007/9/27/pubmed PY - 2008/2/8/medline PY - 2007/9/27/entrez SP - 4678 EP - 85 JF - The Journal of clinical endocrinology and metabolism JO - J Clin Endocrinol Metab VL - 92 IS - 12 N2 - CONTEXT AND OBJECTIVE: Hyperinsulinemic hypoglycemia is newly recognized as a rare but important complication after Roux-en-Y gastric bypass (GB). The etiology of the syndrome and metabolic characteristics remain incompletely understood. Recent studies suggest that levels of incretin hormones are increased after GB and may promote excessive beta-cell function and/or growth. PATIENTS AND METHODS: We performed a cross-sectional analysis of metabolic variables, in both the fasting state and after a liquid mixed-meal challenge, in four subject groups: 1) with clinically significant hypoglycemia [neuroglycopenia (NG)] after GB surgery, 2) with no symptoms of hypoglycemia at similar duration after GB surgery, 3) without GB similar to preoperative body mass index of the surgical cohorts, and 4) without GB similar to current body mass index of the surgical cohorts. RESULTS: Insulin and C-peptide after the liquid mixed meal were both higher relative to the glucose level achieved in persons after GB with NG compared with asymptomatic individuals. Glucagon, glucagon-like peptide 1, and glucose-dependent insulinotropic peptide levels were higher in both post-GB surgical groups compared with both overweight and morbidly obese persons, and glucagon-like peptide 1 was markedly higher in the group with NG. Insulin resistance, assessed by homeostasis model assessment of insulin resistance, the composite insulin sensitivity index, or adiponectin, was similar in both post-GB groups. Dumping score was also higher in both GB groups but did not discriminate between asymptomatic and symptomatic patients. Notably, the frequency of asymptomatic hypoglycemia after a liquid mixed meal was high in post-GB patients. CONCLUSION: A robust insulin secretory response was associated with postprandial hypoglycemia in patients after GB presenting with NG. Increased incretin levels may contribute to the increased insulin secretory response. SN - 0021-972X UR - https://www.unboundmedicine.com/medline/citation/17895322/Patients_with_neuroglycopenia_after_gastric_bypass_surgery_have_exaggerated_incretin_and_insulin_secretory_responses_to_a_mixed_meal_ L2 - https://academic.oup.com/jcem/article-lookup/doi/10.1210/jc.2007-0918 DB - PRIME DP - Unbound Medicine ER -