A controlled study of 45 patients found that patients uncovered that hypoglycemic episodes seemed to be common and yet mostly went unnoticed after bariatric surgery was performed.
A three day period of normal living showed that symptomatic hypoglycemia was present in 22% out of the 15 patients that had gastric bypass surgery, 20% out of the 15 patients that had biliopancreatic diversion with duodenal switch and occurred in none of the patients that did not have surgery and that were non-diabetic. The body mass index of all patients was relatively the same across the board.
Continued glucose monitoring provided evidence that the patients in both post-surgery groups where in hypoglycemia for a significant amount of time. These findings were reported by Dr. Niclas Abrahamsson and associates during the annual scientific session of the American Diabetes Association.
Gastric bypass patients spent an average of 42 minutes each day holding glucose levels under 3.3 mmol/L and an average of 21 minutes each day at levels under 2.8 mmol/L. Those patients that had duodenal switch surgery spent an average of 85 minutes each day at glucose levels under 3.3 mmol/L and levels lower than 2.8 mmol/L for approximately 39 minutes per day. None of the patients that did not go through the surgery had glucose levels of this nature as reported by Dr. Abrahamsson from the University Of Uppsala, Sweden.
The findings of the study were surprising to the team, particularly given that the group that did not go through surgery had no episodes. In addition, the fact that 80% of the hypoglycemic episodes were not noticed by the patients was also surprising. The patients that had gone through duodenal switch surgery had a glucose level of 4.6 mmol/L and were the lowest mean. They also had a hemoglobin level of 29 mmol/mol. These numbers as were compared to the gastric bypass study group with a mean glucose level of 5.3 mmol/L and hemoglobin level of 36 mmol/mol. The group that had no surgery came in with a mean glucose level of 5.9 mmol/L and hemoglobin of 38 mmol/mol.
Upon continuous monitoring the glucose curves were more variable for the gastric bypass patients than those that were less variable from the duodenal switch patients. This difference and variable likely is a result of the glucose absorption capabilities from each surgery as suggested by Dr. Abrahamsson.
Thomas Barber of the University of Warwick, England notes that these test results and study findings are substantial in the way that patients are treated post-surgery and pre-surgery. At present, hypoglycemia isn’t something that is really kept an eye on post-surgery. hypoglycemia can cause brain function difficulty, motor function related issues and cognition problems. Since the hypoglycemia had gone largely unnoticed in the patients, it was not something of grave concern, until these study results.
The presence of this information will likely change the way that practice is managed with relationship to bariatric surgery. Patients will need to be informed of the dangers that could be present with regard to hypoglycemia after surgery. There should be a conversation with the patients about weighting the options prior to surgery and they should be given all of the information.
Surgeons and their teams will also need to be more diligent in their post-operative care with regard to monitoring the patients for hypoglycemia. There should be a change in procedure so that the team members are more acutely aware of the need for such monitoring. There should also be further studies accomplished in order to get the best information possible, determine any differentiating factors between the patients that could be indicators of possible hypoglycemia after surgery.
The study results are instrumental in understanding how patients come through these types of surgery and how the medical community can best protect them against potential problems that occur. This is a good starting point or determining a potential problem and getting resolutions to those problems.