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Acarbose improves hypoglycaemia following gastric bypass surgery without increasing glucagon-like peptide 1 levels.
Obes Surg. 2012 Apr; 22(4):582-6.OS

Abstract

BACKGROUND

Postprandial hypoglycaemia is a severe complication of Roux-en-Y gastric bypass (RYGBP). Acarbose, an α-glucosidase inhibitor (AGI), is employed in its treatment. Several studies have shown that AGIs increase the postprandial levels of glucagon-like peptide 1 (GLP-1). However, an excessive level of GLP-1 is one of the factors involved in the physiopathology of this condition. We analysed the effect of acarbose oral administration in eight RYBGP patients with clinically significant hypoglycaemia or dumping syndrome.

METHODS

Glucose, insulin and GLP-1 plasma levels in fasting and after ingestion of a standard meal (Ensure Plus®; 13 g protein, 50 g carbohydrate, 11 g fat) were measured. The test was repeated the following week with the oral administration of 100 mg of acarbose 15 min prior to the meal.

RESULTS

Five patients developed asymptomatic hypoglycaemia during the test (glucose level <50 mg/dl) with inappropriately high insulin levels and exaggerated GLP-1 response. Acarbose ingestion avoided hypoglycaemia in all of the patients and increased the lowest plasma glucose level (46.4 ± 4.8 vs. 59.0 ± 2.6 mg/dl, p < 0.01). Acarbose ingestion decreased the area under the curve for serum insulin and GLP-1 levels at 15 min after the meal.

CONCLUSIONS

Acarbose avoided postprandial hypoglycaemia following RYGBP by decreasing the hyperinsulinemic response. This was associated with a decrease in early GLP-1 secretion, in contrast to that observed in non-surgical subjects. This finding could be explained by the reduction of glucose load in the jejunum produced by the α-glucosidase inhibition, which is the main stimulus for GLP-1 secretion.

Authors+Show Affiliations

Department of Nutrition, Diabetes and Metabolism, School of Medicine, Pontificia Universidad Catolica de Chile, Santiago, Chile. jpvalder@uc.clNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

22161170

Citation

Valderas, Juan Patricio, et al. "Acarbose Improves Hypoglycaemia Following Gastric Bypass Surgery Without Increasing Glucagon-like Peptide 1 Levels." Obesity Surgery, vol. 22, no. 4, 2012, pp. 582-6.
Valderas JP, Ahuad J, Rubio L, et al. Acarbose improves hypoglycaemia following gastric bypass surgery without increasing glucagon-like peptide 1 levels. Obes Surg. 2012;22(4):582-6.
Valderas, J. P., Ahuad, J., Rubio, L., Escalona, M., Pollak, F., & Maiz, A. (2012). Acarbose improves hypoglycaemia following gastric bypass surgery without increasing glucagon-like peptide 1 levels. Obesity Surgery, 22(4), 582-6. https://doi.org/10.1007/s11695-011-0581-0
Valderas JP, et al. Acarbose Improves Hypoglycaemia Following Gastric Bypass Surgery Without Increasing Glucagon-like Peptide 1 Levels. Obes Surg. 2012;22(4):582-6. PubMed PMID: 22161170.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Acarbose improves hypoglycaemia following gastric bypass surgery without increasing glucagon-like peptide 1 levels. AU - Valderas,Juan Patricio, AU - Ahuad,Jessica, AU - Rubio,Lorena, AU - Escalona,Manuel, AU - Pollak,Felipe, AU - Maiz,Alberto, PY - 2011/12/14/entrez PY - 2011/12/14/pubmed PY - 2012/6/6/medline SP - 582 EP - 6 JF - Obesity surgery JO - Obes Surg VL - 22 IS - 4 N2 - BACKGROUND: Postprandial hypoglycaemia is a severe complication of Roux-en-Y gastric bypass (RYGBP). Acarbose, an α-glucosidase inhibitor (AGI), is employed in its treatment. Several studies have shown that AGIs increase the postprandial levels of glucagon-like peptide 1 (GLP-1). However, an excessive level of GLP-1 is one of the factors involved in the physiopathology of this condition. We analysed the effect of acarbose oral administration in eight RYBGP patients with clinically significant hypoglycaemia or dumping syndrome. METHODS: Glucose, insulin and GLP-1 plasma levels in fasting and after ingestion of a standard meal (Ensure Plus®; 13 g protein, 50 g carbohydrate, 11 g fat) were measured. The test was repeated the following week with the oral administration of 100 mg of acarbose 15 min prior to the meal. RESULTS: Five patients developed asymptomatic hypoglycaemia during the test (glucose level <50 mg/dl) with inappropriately high insulin levels and exaggerated GLP-1 response. Acarbose ingestion avoided hypoglycaemia in all of the patients and increased the lowest plasma glucose level (46.4 ± 4.8 vs. 59.0 ± 2.6 mg/dl, p < 0.01). Acarbose ingestion decreased the area under the curve for serum insulin and GLP-1 levels at 15 min after the meal. CONCLUSIONS: Acarbose avoided postprandial hypoglycaemia following RYGBP by decreasing the hyperinsulinemic response. This was associated with a decrease in early GLP-1 secretion, in contrast to that observed in non-surgical subjects. This finding could be explained by the reduction of glucose load in the jejunum produced by the α-glucosidase inhibition, which is the main stimulus for GLP-1 secretion. SN - 1708-0428 UR - https://www.unboundmedicine.com/medline/citation/22161170/Acarbose_improves_hypoglycaemia_following_gastric_bypass_surgery_without_increasing_glucagon_like_peptide_1_levels_ L2 - https://dx.doi.org/10.1007/s11695-011-0581-0 DB - PRIME DP - Unbound Medicine ER -