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Obesity Surgery
Published in: Obesity Surgery 9/2016

01-09-2016 | Original Contributions

Continuous Glucose Monitoring After Gastric Bypass to Evaluate the Glucose Variability After a Low-Carbohydrate Diet and to Determine Hypoglycemia

Authors: Joan Bach Nielsen, Caroline Bruun Abild, Ane Mathilde Pedersen, Steen Bønløkke Pedersen, Bjørn Richelsen

Published in: Obesity Surgery | Issue 9/2016

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Abstract

Background

Roux-en-Y gastric bypass (RYGB) alters glucose metabolism and can cause postprandial hypoglycemia. Continuous glucose monitoring (CGM) has been proposed as an evaluation tool in hypoglycemic RYGB individuals. The objective of this study is to investigate the use of CGM in clinical decision-making including diagnosing hypoglycemia and evaluating treatment effects. Furthermore, we aim to assess its accuracy in RYGB-operated individuals.

Methods

Thirteen RYGB individuals with symptomatic hypoglycemia and 13 asymptomatic RYGB individuals underwent CGM for 5 days. During this period, a mixed-meal test with concomitant plasma glucose (PG) measurements was performed. Furthermore, the RYGB individuals followed a low-carbohydrate diet (LCD) for 1 day and maintained their ordinary diet (OD) for the rest of the period.

Results

LCD reduced the CGM-determined glycemic variability of the mean interstitial fluid glucose (IFG) significantly compared to OD (p < 0.0001). Receiver operating characteristic analysis confirmed that low blood glucose index (e.g., the frequency and amplitude of hypoglycemic events) is the most reliable parameter related to the development of symptomatic hypoglycemia, with a sensitivity of 0.91 (confidence interval [CI] 0.59; 1.00) and a specificity of 0.77 (CI 0.46; 0.95). However, CGM, measuring the IFG in the subcutaneous adipose tissue, overestimated the minimum glucose levels by 1.1 ± 0.9 mmol/l compared with PG.

Conclusions

CGM was a good method for demonstrating increased glycemic variability among RYGB individuals and for displaying dietary effects on reducing this glycemic variability, including hypoglycemic events. In RYGB individuals, CGM-measured IFG overestimated the real glucose value by about 1 mmol/l in the hypoglycemic range. This should be taken into consideration if CGM is used to diagnose hypoglycemia after RYGB.
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Metadata
Title
Continuous Glucose Monitoring After Gastric Bypass to Evaluate the Glucose Variability After a Low-Carbohydrate Diet and to Determine Hypoglycemia
Authors
Joan Bach Nielsen
Caroline Bruun Abild
Ane Mathilde Pedersen
Steen Bønløkke Pedersen
Bjørn Richelsen
Publication date
01-09-2016
Publisher
Springer US
Published in
Obesity Surgery / Issue 9/2016
Print ISSN: 0960-8923
Electronic ISSN: 1708-0428
DOI
https://doi.org/10.1007/s11695-016-2058-7

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