FRI664 The Impact Of Prediabetes Diagnosis On The Prevalence Of Postbariatric Hypoglycemia

Abstract

Abstract Disclosure: J.R. Shariff: None. L. Funk: None. A. Zaveri: None. D.B. Davis: None. Bariatric surgery is not only a mainstay of obesity treatment, but it can result in remission of metabolic conditions, such as Type 2 diabetes. Post-operatively however, patients can develop postbariatric hypoglycemia (PBH), which is thought to be due to changes in insulin sensitivity and hypersecretion after eating. It has been suggested that prior type 2 diabetes can protect against PBH as decreased β-cell function prevents hyperinsulinemia. Patients with prediabetes may not have deterioration of β-cell function resulting in increased insulin production in response to glycemic excursion and subsequent hypoglycemia. The study aimed to assess the prevalence and severity of PBH in patients with prediabetes compared to those without prediabetes prior to bariatric surgery. We conducted a retrospective cohort study of patients 18 years and older who underwent either Roux-en-Y gastric bypass or sleeve gastrectomy between 2014 and 2021 and did not have a history of type 1 or type 2 diabetes mellitus at a single academic medical center. A history of PBH (hypoglycemia reported or documented after eating, symptoms of hypoglycemia, and resolution of symptoms after eating) and prediabetes (defined as A1c 5.7-6.4%, fasting glucose of 100-125mg/dL, or oral glucose tolerance testing with 2-hour glucose 140-199mg/dL) was determined based on medical record review. 14 patients developed PBH out of 539 (2.6%). 110 patients had prediabetes (20.4%). Of these 110 patients, 4 had PBH (3.6%). Of the 429 patients without prediabetes, 10 patients had PBH (2.3%). There was a greater post-operative weight loss, on average, in patients with PBH (19.5%) than in those without PBH (15.9%), although it should be noted that all PBH patients had Roux en Y gastric bypass. Interestingly, only 15% of the PBH population appeared to be on pharmacologic treatment, despite 21.5% being hospitalized or in the emergency room for hypoglycemic events. Most PBH patients (64.3%) developed symptoms between 1 to 3 years post-operatively, which is consistent with other studies on this topic. There was no association between prediabetes and PBH in our dataset (p=0.46), however our data set was quite small and it may be difficult to draw significant conclusions. A larger scale study done in a prospective manner would be useful for further research. Presentation: Friday, June 16, 2023