Patients with Neuroglycopenia after Gastric Bypass Surgery Have Exaggerated Incretin and Insulin Secretory Responses to a Mixed Meal

Context and Objective: Hyperinsulinemic hypoglycemia is newly recognized as a rare but important complication after Roux-en-Y gastric bypass (GB). The etiology of the syndrome and metabolic characteristics remain incompletely understood. Recent studies suggest that levels of incretin hormones are in...

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Published in:The journal of clinical endocrinology and metabolism 2007-12, Vol.92 (12), p.4678-4685
Main Authors: Goldfine, A. B, Mun, E. C, Devine, E, Bernier, R, Baz-Hecht, M, Jones, D. B, Schneider, B. E, Holst, J. J, Patti, M. E
Format: Article
Language:English
Subjects:
Adult
Aged
Biological and medical sciences
Blood Glucose - analysis
Blood Glucose - metabolism
Body Mass Index
C-Peptide - blood
Eating - physiology
Endocrinopathies
Feeding. Feeding behavior
Female
Food
Fundamental and applied biological sciences. Psychology
Gastric Bypass - adverse effects
Gastric Inhibitory Polypeptide - metabolism
Glucagon - blood
Glucagon-Like Peptide 1 - metabolism
Humans
Hypoglycemia - etiology
Incretins - blood
Insulin - blood
Insulin Resistance - physiology
Male
Medical sciences
Middle Aged
Obesity - metabolism
Obesity, Morbid - metabolism
Postoperative Complications - metabolism
Vertebrates: anatomy and physiology, studies on body, several organs or systems
Vertebrates: endocrinology
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Summary:Context and Objective: Hyperinsulinemic hypoglycemia is newly recognized as a rare but important complication after Roux-en-Y gastric bypass (GB). The etiology of the syndrome and metabolic characteristics remain incompletely understood. Recent studies suggest that levels of incretin hormones are increased after GB and may promote excessive β-cell function and/or growth. Patients and Methods: We performed a cross-sectional analysis of metabolic variables, in both the fasting state and after a liquid mixed-meal challenge, in four subject groups: 1) with clinically significant hypoglycemia [neuroglycopenia (NG)] after GB surgery, 2) with no symptoms of hypoglycemia at similar duration after GB surgery, 3) without GB similar to preoperative body mass index of the surgical cohorts, and 4) without GB similar to current body mass index of the surgical cohorts. Results: Insulin and C-peptide after the liquid mixed meal were both higher relative to the glucose level achieved in persons after GB with NG compared with asymptomatic individuals. Glucagon, glucagon-like peptide 1, and glucose-dependent insulinotropic peptide levels were higher in both post-GB surgical groups compared with both overweight and morbidly obese persons, and glucagon-like peptide 1 was markedly higher in the group with NG. Insulin resistance, assessed by homeostasis model assessment of insulin resistance, the composite insulin sensitivity index, or adiponectin, was similar in both post-GB groups. Dumping score was also higher in both GB groups but did not discriminate between asymptomatic and symptomatic patients. Notably, the frequency of asymptomatic hypoglycemia after a liquid mixed meal was high in post-GB patients. Conclusion: A robust insulin secretory response was associated with postprandial hypoglycemia in patients after GB presenting with NG. Increased incretin levels may contribute to the increased insulin secretory response.
ISSN:0021-972X
1945-7197
DOI:10.1210/jc.2007-0918