Post-Bariatric Hypoglycemia: an Impaired Metabolic Response to a Meal

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2024年8月17日

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Ömrüm Aydin,
Abraham S. Meijnikman,
Patrick A. de Jonge,
Karlijn van Stralen,
Hanneke Börger,
Kadriye Okur,
Zainab Iqbal,
Moritz V. Warmbrunn,
Yair I. Z. Acherman,
Sjoerd Bruin,
Maaike Winkelmeijer,
Alinda W. M. Schimmel,
Jens J. Holst,
Steen S. Poulsen,
Fredrik Bäckhed,
Max Nieuwdorp,
Albert K. Groen,
Victor E. A. Gerdes

摘要

Aims/Hypothesis

Post-bariatric hypoglycemia (PBH) is caused by postprandial hyperinsulinemia, due to anatomical alterations and changes in post-prandial metabolism after bariatric surgery. The mechanisms underlying the failing regulatory and compensatory systems are unclear. In this study, we investigated the differences in post-prandial hormones and metabolic profiles between patients with and without PBH.

Methods

We performed a mixed meal test (MMT) in 63 subjects before and 1 year after Roux-en-Y gastric bypass (RYGB) surgery. Blood was withdrawn at 0, 10, 20, 30, 60, and 120 min after ingestion of a standardized meal. Glucose, insulin, GLP-1, FGF-19, and FGF-21 were measured and untargeted metabolomics analysis was performed on blood plasma to analyze which hormonal and metabolic systems were altered between patients with and without PBH.

Results

Out of 63, a total of 21 subjects (33%) subjects developed PBH (glucose < 3.1 mmol/L) after surgery. Decreased glucose and increased insulin excursions during MMT were seen in PBH (p < 0.05). GLP-1, FGF-19, and FGF-21 were elevated after surgery (p < 0.001), but did not differ between PBH and non-PBH groups. We identified 20 metabolites possibly involved in carbohydrate metabolism which differed between the two groups, including increased carnitine and acylcholines in PBH.

Conclusion

Overall, 33% of the subjects developed PBH 1 year after RYGB surgery. While GLP-1, FGF-19, and FGF-21 were similar in PBH and non-PBH patients, metabolomics analysis revealed changes in carnitine and acyclcholines that are possibly involved in energy metabolism, which may play a role in the occurrence of PBH.

Graphical Abstract