Relationship between symptom perception and postprandial glycaemic profiles in patients with post-bariatric hypoglycaemia after Roux-en-Y gastric bypass surgery

  

Objective

Post-bariatric surgery hypoglycaemia (PBH) is a metabolic complication of Roux-en-Y gastric bypass (RYGB). Since symptoms are a key component of the Whipple’s triad to diagnose non-diabetic hypoglycaemia, we evaluated the relationship between self-reported symptoms and postprandial sensor glucose profiles. 

Research Design and Methods

Thirty patients with PBH after RYGB (age: 50.1 [41.6-60.6] years, 86.7% female, BMI: 26.5 [23.5-31.2] kg/m2; median [interquartile range]) wore a blinded Dexcom G6 sensor while recording autonomic, neuroglycopenic and gastrointestinal symptoms over 50 days. Symptoms (overall and each type) were categorised into those occurring in postprandial periods (PPPs) without hypoglycaemia, or in the preceding dynamic or hypoglycaemic phase of PPPs with hypoglycaemia (nadir sensor glucose <3.9 mmol/L). We further explored the relationship between symptoms and the maximum negative rate of sensor glucose change and nadir sensor glucose levels. 

Results

In 5851 PPPs, 775 symptoms were reported, of which 30.6 [0.0-59.9]% were perceived in PPPs without hypoglycaemia, 16.7 [0.0-30.1]% in the preceding dynamic phase and 45.0 [13.7-84.7]% in the hypoglycaemic phase of PPPs with hypoglycaemia. Per symptom type, 53.6 [23.8-100.0]% of the autonomic, 30.0 [5.6-80.0]% of the neuroglycopenic and 10.4 [0.0-50.0]% of the gastrointestinal symptoms occurred in the hypoglycaemic phase of PPPs with hypoglycaemia. Both faster glucose dynamics and lower nadir sensor glucose levels were related with symptom perception. 

Conclusions

The relationship between symptom perception and PBH is complex, challenging clinical judgement and decision-making in this population.