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Postprandial hypoglycaemia after Roux-en-Y gastric bypass and the effects of acarbose, sitagliptin, verapamil, liraglutide and pasireotide.
Diabetes Obes Metab. 2019 09; 21(9):2142-2151.DO

Abstract

AIM

To investigate the effects of acarbose, sitagliptin, verapamil, liraglutide and pasireotide on post-bariatric hypoglycaemia (PBH) after Roux-en-Y gastric bypass.

MATERIALS AND METHODS

In a randomized crossover study, 11 women who had undergone Roux-en-Y gastric bypass and had documented hypoglycaemia were each evaluated during a baseline period without treatment and during five treatment periods with the following interventions: acarbose 50 mg for 1 week, sitagliptin 100 mg for 1 week, verapamil 120 mg for 1 week, liraglutide 1.2 mg for 3 weeks and pasireotide 300 μg as a single dose. Treatment effects were evaluated by a mixed-meal tolerance test (MMTT) and, for all treatment periods except pasireotide, by 6 days of continuous glucose monitoring (CGM).

RESULTS

Treatment with acarbose and treatment with pasireotide both significantly lifted nadir glucose levels (mean ± SEM 3.9 ± 0.2 and 7.9 ± 0.4 vs 3.4 ± 0.2; P < .03) and reduced time in hypoglycaemia during the MMTTs. Acarbose reduced peak glucose levels and time in hyperglycaemia, whereas pasireotide greatly increased both variables. Acarbose and pasireotide reduced insulin and C-peptide levels, and pasireotide also diminished glucagon-like peptide-1 levels. Sitagliptin lowered nadir glucose values, while verapamil and liraglutide had no effect on hypoglycaemia. During the CGM periods, the treatments had no impact on hypoglycaemia, whereas acarbose and liraglutide reduced hyperglycaemia and glycaemic variability.

CONCLUSIONS

In an experimental setting, treatment with acarbose and pasireotide reduced PBH. Acarbose appears to have an overall glucose-stabilizing effect, whereas pasireotide leads to increased and sustained hyperglycaemia.

Authors+Show Affiliations

Department of Medicine, Zealand University Hospital, Køge, Denmark.Department of Medicine, Amager Hospital, Amager, Denmark.Department of Medicine, Zealand University Hospital, Køge, Denmark.Department of Medicine, Zealand University Hospital, Køge, Denmark.Department of Biomedical Sciences and Novo Nordisk Foundation Centre for Basic Metabolic Research, University of Copenhagen, Copenhagen, Denmark.Department of Medicine, Zealand University Hospital, Køge, Denmark.Clinical Department, Steno Diabetes Center, Copenhagen, Denmark.

Pub Type(s)

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

Language

eng

PubMed ID

31144430

Citation

Øhrstrøm, Caroline Christfort, et al. "Postprandial Hypoglycaemia After Roux-en-Y Gastric Bypass and the Effects of Acarbose, Sitagliptin, Verapamil, Liraglutide and Pasireotide." Diabetes, Obesity & Metabolism, vol. 21, no. 9, 2019, pp. 2142-2151.
Øhrstrøm CC, Worm D, Højager A, et al. Postprandial hypoglycaemia after Roux-en-Y gastric bypass and the effects of acarbose, sitagliptin, verapamil, liraglutide and pasireotide. Diabetes Obes Metab. 2019;21(9):2142-2151.
Øhrstrøm, C. C., Worm, D., Højager, A., Andersen, D., Holst, J. J., Kielgast, U. L., & Hansen, D. L. (2019). Postprandial hypoglycaemia after Roux-en-Y gastric bypass and the effects of acarbose, sitagliptin, verapamil, liraglutide and pasireotide. Diabetes, Obesity & Metabolism, 21(9), 2142-2151. https://doi.org/10.1111/dom.13796
Øhrstrøm CC, et al. Postprandial Hypoglycaemia After Roux-en-Y Gastric Bypass and the Effects of Acarbose, Sitagliptin, Verapamil, Liraglutide and Pasireotide. Diabetes Obes Metab. 2019;21(9):2142-2151. PubMed PMID: 31144430.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Postprandial hypoglycaemia after Roux-en-Y gastric bypass and the effects of acarbose, sitagliptin, verapamil, liraglutide and pasireotide. AU - Øhrstrøm,Caroline Christfort, AU - Worm,Dorte, AU - Højager,Anna, AU - Andersen,Ditte, AU - Holst,Jens Juul, AU - Kielgast,Urd Lynge, AU - Hansen,Dorte Lindqvist, Y1 - 2019/06/24/ PY - 2019/03/19/received PY - 2019/05/17/revised PY - 2019/05/28/accepted PY - 2019/5/31/pubmed PY - 2020/7/14/medline PY - 2019/5/31/entrez KW - GLP-1 KW - bariatric surgery KW - clinical trial KW - continuous glucose monitoring KW - hypoglycaemia SP - 2142 EP - 2151 JF - Diabetes, obesity & metabolism JO - Diabetes Obes Metab VL - 21 IS - 9 N2 - AIM: To investigate the effects of acarbose, sitagliptin, verapamil, liraglutide and pasireotide on post-bariatric hypoglycaemia (PBH) after Roux-en-Y gastric bypass. MATERIALS AND METHODS: In a randomized crossover study, 11 women who had undergone Roux-en-Y gastric bypass and had documented hypoglycaemia were each evaluated during a baseline period without treatment and during five treatment periods with the following interventions: acarbose 50 mg for 1 week, sitagliptin 100 mg for 1 week, verapamil 120 mg for 1 week, liraglutide 1.2 mg for 3 weeks and pasireotide 300 μg as a single dose. Treatment effects were evaluated by a mixed-meal tolerance test (MMTT) and, for all treatment periods except pasireotide, by 6 days of continuous glucose monitoring (CGM). RESULTS: Treatment with acarbose and treatment with pasireotide both significantly lifted nadir glucose levels (mean ± SEM 3.9 ± 0.2 and 7.9 ± 0.4 vs 3.4 ± 0.2; P < .03) and reduced time in hypoglycaemia during the MMTTs. Acarbose reduced peak glucose levels and time in hyperglycaemia, whereas pasireotide greatly increased both variables. Acarbose and pasireotide reduced insulin and C-peptide levels, and pasireotide also diminished glucagon-like peptide-1 levels. Sitagliptin lowered nadir glucose values, while verapamil and liraglutide had no effect on hypoglycaemia. During the CGM periods, the treatments had no impact on hypoglycaemia, whereas acarbose and liraglutide reduced hyperglycaemia and glycaemic variability. CONCLUSIONS: In an experimental setting, treatment with acarbose and pasireotide reduced PBH. Acarbose appears to have an overall glucose-stabilizing effect, whereas pasireotide leads to increased and sustained hyperglycaemia. SN - 1463-1326 UR - https://www.unboundmedicine.com/medline/citation/31144430/Postprandial_hypoglycaemia_after_Roux_en_Y_gastric_bypass_and_the_effects_of_acarbose_sitagliptin_verapamil_liraglutide_and_pasireotide_ L2 - https://doi.org/10.1111/dom.13796 DB - PRIME DP - Unbound Medicine ER -