Roux-en-Y gastric bypass resulted in a 29% incidence of reactive hypoglycemia at 1 year compared to 14% with sleeve gastrectomy (P=0.079).
RCT (n=120)
Open-label
1:1
No
Does Roux-en-Y gastric bypass compared to sleeve gastrectomy affect the incidence of reactive hypoglycemia in patients undergoing bariatric surgery?
While reactive hypoglycemia is common after both procedures, Roux-en-Y gastric bypass is associated with more severe hypoglycemic episodes requiring hospitalization compared to sleeve gastrectomy.
Absolute Event Rate: 29% vs 14%
p-value: p=0.079
Context: We compared the incidence of hypoglycemia after Roux-en-Y gastric bypass (RYGB) vs sleeve gastrectomy (SG). Design, Setting, and Main Outcome Measures: Randomized, open-label trial conducted at the outpatient obesity clinic in a university hospital in Rome, Italy. The primary aim was the incidence of reactive hypoglycemia (<3.1 mmol/L after 75-g oral glucose load) at 1 year after surgery. Secondary aims were hypoglycemia under everyday life conditions, insulin sensitivity, insulin secretion, and lipid profile. Results: Of 175 eligible patients, 120 were randomized 1:1 to RYGB or SG; 117 (93%) completed the 12-month follow-up. Reactive hypoglycemia was detected in 14% and 29% of SG and RYGB patients (P = 0.079), respectively, with the effect of treatment in multivariate analysis significant at P = 0.018. Daily hypoglycemic episodes during continuous glucose monitoring did not differ between groups (P = 0.75). Four of 59 RYGB subjects (6.8%) had 1 to 3 hospitalizations for symptomatic hypoglycemia vs 0 in SG. The static β-cell glucose sensitivity index increased after both treatments (P < 0.001), but the dynamic β-cell glucose sensitivity index increased significantly in SG (P = 0.008) and decreased in RYGB (P = 0.004 for time × treatment interaction). Whole-body insulin sensitivity increased about 10-fold in both groups. Conclusions: We show that reactive hypoglycemia is no less common after SG and is not a safer option than RYGB, but RYGB is associated with more severe hypoglycemic episodes. This is likely due to the lack of improvement of β-cell sensitivity to changes in circulating glucose after RYGB, which determines an inappropriately high insulin secretion.
Capristo et al. (Fri,) conducted a rct in Obesity (n=120). Roux-en-Y gastric bypass (RYGB) vs. Sleeve gastrectomy (SG) was evaluated on incidence of reactive hypoglycemia (<3.1 mmol/L after 75-g oral glucose load) at 1 year after surgery (p=0.079). Roux-en-Y gastric bypass resulted in a 29% incidence of reactive hypoglycemia at 1 year compared to 14% with sleeve gastrectomy (P=0.079).