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Open Access 13-11-2024 | Hypoglycemia | Research

Increased Risk of Hypoglycemia Following Roux-en-Y Gastric Bypass Surgery in Patients Without Diabetes: a Propensity Score-Matched Analysis

Authors: Eman A. Toraih, Mohamed Doma, Aria Kaur Atwal, Benito Vlassis, Ahmed Abdelmaksoud, Hani Aiash, Runa Acharya

Published in: Obesity Surgery | Issue 12/2024

Abstract

Background

Roux-en-Y gastric bypass (RYGB) surgery is an effective treatment for obesity. However, the incidence and long-term risk of hypoglycemia after surgery in patients without diabetes remains unclear. This study aimed to investigate the prevalence of hypoglycemia following RYGB surgery in patients with obesity and without diabetes.

Methods

A retrospective cohort study was conducted using the TriNetX database. The study population included 15,085 patients with obesity (BMI ≥ 30 kg/m²) who underwent RYGB surgery and 3,200,074 non-surgical controls, all without a history of diabetes or GLP-1 receptor agonist use. Propensity score matching was performed to balance baseline characteristics. The primary outcome was the incidence of hypoglycemia, defined by ICD-10-CM codes or laboratory values (glucose ≤ 70 mg/dL). Cox regression analysis was employed to calculate hazard ratios (HR) and 95% confidence intervals (CI).

Results

In the overall study population, the risk of hypoglycemia was significantly higher in the RYGB group (18.70%, n = 2,810) compared to the control group (3.80%, n = 120,923; HR 4.3, 95% CI 4.14–4.46, p < 0.001). After propensity score matching (n = 14,916 per group), RYGB patients maintained an elevated risk (18.70%, n = 2,795) compared to matched controls (5.0%, n = 749; HR 3.7, 95% CI 3.44–4.05, p < 0.001). Time-series analysis revealed consistently higher hypoglycemia risk in the RYGB group, with hazard ratios ranging from 5.37 (95% CI 4.09–7.03) at 1 week to 3.75 (95% CI 3.45–4.06) at 10 years post-surgery (all p < 0.001). Subgroup analysis of RYGB patients who developed hypoglycemia showed a 30-day hospitalization rate of 21.3% and a mortality rate of 0.71%.

Conclusion

RYGB surgery is associated with a significantly increased risk of hypoglycemia in patients with obesity and without diabetes, both in the short-term and long-term follow-up. These findings underscore the importance of monitoring and managing hypoglycemia in patients undergoing RYGB surgery, even in the absence of preexisting diabetes.

Graphical Abstract

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Title: Increased Risk of Hypoglycemia Following Roux-en-Y Gastric Bypass Surgery in Patients Without Diabetes: a Propensity Score-Matched Analysis
Authors: Eman A. Toraih
Mohamed Doma
Aria Kaur Atwal
Benito Vlassis
Ahmed Abdelmaksoud
Hani Aiash
Runa Acharya
Publication date: 13-11-2024
Publisher: Springer US
Keywords: Hypoglycemia
Obesity
Obesity
Bariatric Surgery
Bariatric Surgery
Published in: Obesity Surgery / Issue 12/2024
Print ISSN: 0960-8923
Electronic ISSN: 1708-0428
DOI: https://doi.org/10.1007/s11695-024-07565-y

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Increased Risk of Hypoglycemia Following Roux-en-Y Gastric Bypass Surgery in Patients Without Diabetes: a Propensity Score-Matched Analysis

Abstract

Background

Methods

Results

Conclusion

Graphical Abstract

Other articles of this Issue 12/2024

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