Introduction and Objective: Roux-en-Y gastric bypass (RYGB) induces long term remission of type 2 diabetes in 80% of patients, but approximately 30% develop post-bariatric hypoglycemia (PBH) characterized by frequent neuroglycopenic episodes. Prior work suggests that altered nutrient transit after surgery leads to exaggerated incretin and insulin responses, but factors distinguishing the subset of patients who develop PBH are unclear. We hypothesized that faster gastric pouch emptying increases PBH risk and that slowing gastric emptying with GLP-1a treatment would improve hypoglycemia. Methods: Patients with diagnosed PBH (n=17) were compared to 10 RYGB without PBH (surgical controls) and 12 non-surgical controls, concerning gastric emptying measured by solid meal scintigraphy. A subset of 16 PBH patients (11 RYGB and 5 sleeve gastrectomy) did a 12-wk crossover study to determine if GLP-1a treatment slowed gastric emptying and reduced hypoglycemia. This cohort underwent solid meal scintigraphy (n = 6) and/or glucose testing (n = 12) during standardized mixed meal tolerance test on and off GLP-1a treatment. Results: Gastric emptying was markedly accelerated in PBH patients compared to both non-surgical and surgical controls. 1-hr residual volume was significantly lower in PBH patients vs surgical controls (5.6% vs 17.9% p=0.031) and nonsurgical controls (45.6%, p0.001). GLP-1a treatment significantly slowed gastric emptying in PBH patients, increasing 1-hr residual volume to 22.4% (p=0.038). GLP-1a therapy increased postprandial glucose peak (192 vs 169 mg/dL p=0.009) but did not alter glucose nadir. Conclusion: Patients with PBH exhibit significantly faster gastric emptying than asymptomatic RYGB controls. While GLP-1a significantly slows emptying in RYGB and SG patients, on average there is no reduction in hypoglycemia during a standardized meal test. GLP-1a may offer clinical benefits via other mechanisms such as increased adherence to low-carbohydrate diet, but this remains to be demonstrated. Disclosure N. Turk: None. J. Yang: None. E. Yandle: None. D. Azagury: Advisory Panel; Current; Endolumik, Form health, Moon Surgical, GI windows. M. Esquivel: Consultant; Current; Intuitive Surgical. T. McLaughlin: Research Support; Ended; Lilly. Advisory Panel; Ended; Regeneron Pharmaceuticals Inc. Research Support; Current; Recordati S.p.A. Stock/Shareholder; Current; January, Inc. Research Support; Current; WW International, Inc. Consultant; Ended; Eiger BioPharmaceuticals. Advisory Panel; Current; Amylyx. Consultant; Current; Oura. Research Support; Current; Dexcom, Inc. Funding American Diabetes Association (1-19-ICTS-073)
Turk et al. (Fri,) studied this question.