Abstract
BackgroundBariatric surgery improves glucose homeostasis; however, side effects such as hypoglycemia can occur. We investigated the effects of meals on interstitial glucose (IG) response in biliopancreatic diversion with duodenal switch (BPD-DS) and Roux-en-Y gastric bypass (RYGBP)-operated patients at least 1 year after surgery.MethodsThirty patients treated with BPD-DS or RYGBP were recruited at the outpatient Obesity Unit, Uppsala University Hospital. IG was measured by continuous glucose monitoring (CGM) for 3 consecutive days, and postprandial IG levels from 5 to 120 min were analyzed for 2 of these days. All intake of food and beverages was simultaneously registered in a food diary, which was processed using The Meal Pattern Questionnaire.ResultsPostprandial IG levels were significantly lower in BPD-DS (n = 14) compared to RYGBP (n = 15)-treated patients, with mean concentrations of 5.0 (± 1.0) and 6.3 (± 1.8) mmol/L respectively (p < 0.001). The mean postprandial IG increment was lower in BPD-DS than in RYGBP patients, 0.2 (± 0.6) vs. 0.4 (± 1.4) mmol/L (p < 0.001). Furthermore, the postprandial IG variability was less pronounced in BPD-DS than in RYGBP patients. The mean number of daily meals did not differ between the two groups, 7.8 (± 2.6) in BPD-DS and 7.2 (± 1.7) in the RYGBP (p = 0.56).ConclusionBPD-DS patients demonstrated lower postprandial IG concentrations, with smaller postprandial IG increments and less pronounced postprandial IG variability compared to RYGBP patients. The two groups had similar meal pattern and the postprandial IG responses is probably associated with differences in postoperative physiology.
Highlights
In Sweden, about 6000 patients with morbid obesity are treated annually with bariatric surgery
Because of significant differences in variance between glucose measurements in the biliopancreatic diversion with duodenal switch (BPD-DS) and Roux-en-Y gastric bypass (RYGBP) group, a two-tailed t test for unequal variance was used for group comparisons
BPD-DS patients demonstrated a larger reduction in BMI after surgery as well as lower circulating glucose and HbA1c levels when compared to RYGBP patients (Table 1)
Summary
In Sweden, about 6000 patients with morbid obesity are treated annually with bariatric surgery. Biliopancreatic diversion with duodenal switch (BPD-DS) is most often reserved for patients with BMI > 50 kg/m2 and accounts for less than 1% of all bariatric surgery [1]. Primary laparoscopic Roux-enY gastric bypass (RYGBP) is performed in 55% of these cases. Both of these bariatric methods result in improved or normalized glucometabolic status [2, 3]. Bariatric surgery improves glucose homeostasis; side effects such as hypoglycemia can occur. We investigated the effects of meals on interstitial glucose (IG) response in biliopancreatic diversion with duodenal switch (BPD-DS) and Roux-en-Y gastric bypass (RYGBP)-operated patients at least 1 year after surgery
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