Nationwide cohort study of post-gastric bypass hypoglycaemia including 5,040 patients undergoing surgery for obesity in 1986–2006 in Sweden
Open accessAbstract
Aims/hypothesis Symptomatic hypoglycaemia with related confusion, syncope, epilepsy or seizures is a newly recognised complication of gastric bypass surgery for obesity. The incidence of these conditions is not known. We therefore studied the incidence of post-gastric bypass hypoglycaemia and related symptoms in patients who have undergone gastric bypass and a reference cohort from the general population of Sweden.Methods This is a nationwide cohort study based on national registries with 5,040 persons who underwent gastric bypass, vertical banded gastroplasty or gastric banding for obesity in Sweden between 1 January 1986 and 31 December 2006 and a cohort of ten referents per patient matched for sex and age randomly sampled from the general population. The incidence rates of hospitalisation for hypoglycaemia, confusion, syncope, epilepsy or seizures before and after dates of surgery or inclusion in the reference cohort were studied.Results Preoperative incidences of hospitalisation for hypoglycaemia were similar in the surgical and referent cohorts. After gastric bypass surgery, the adjusted hazard ratios were significantly elevated for hypoglycaemia (2.7 [95% CI 1.2-6.3]), confusion (2.8 [1.3-6.0]), syncope (4.9 [3.4-7.0]), epilepsy (3.0 [2.1-4.3]) and seizures (7.3 [5.0-10.8]). The proportions of gastric bypass patients and reference participants affected by hypoglycaemia were very low (0.2% and 0.04%, respectively). There was no increased risk of hypoglycaemia after vertical banded gastroplasty or gastric banding compared with the referent population.Conclusions/interpretation Obese persons who have undergone gastric bypass have an increased risk of hospitalisation for diagnoses associated with post-gastric bypass hypoglycaemia, although few patients are affected.
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Post-RYGB hyperinsulinemic hypoglycemia may involve β-cell hypertrophy or neogenesis.
“post-RYGB hyperinsulinemic hypoglycemia may involve β-cell hypertrophy or neogenesis as well ( 80 , 81 ).”
From β-Cell Failure in Type 2 Diabetes: Postulated Mechanisms and Prospects for Prevention and Treatment (2014) · cites this paper as [81]
The Discussion (page unavailable) considers increased islet functional activity as a possible mechanism of post-gastric-bypass hypoglycaemia. It does not propose β-cell hypertrophy or neogenesis; those specific structural mechanisms are unsupported by this paper. (LLM, conf=0.83)
Experimental — accuracy not yet measuredA Swedish nationwide cohort study of 5,040 post-gastric bypass patients demonstrated that approximately 1% were hospitalized for hypoglycemia and/or related disorders at a median of 2.7 years after surgery.
“Furthermore, a Swedish nationwide cohort study of 5,040 post-gastric bypass patients demonstrated that approximately 1% were hospitalized for hypoglycemia and/or related disorders at a median of 2.7 years after surgery (19).”
From Dumping syndrome after esophageal, gastric or bariatric surgery: Pathophysiology, diagnosis, and management (2017) · cites this paper as [19]
The Results report 5,040 gastric bypass patients and a median of 2.7 years from surgery to inpatient care for hypoglycaemia. Table 2 reports percentages for each diagnosis separately: 0.18% for hypoglycaemia and up to 0.99% for related conditions. It does not establish that approximately 1% were hospitalized for hypoglycaemia and/or related disorders combined, or that the 2.7-year median applies to all those disorders. (LLM, conf=0.86)
Experimental — accuracy not yet measuredPatients were also at increased risk for confusion, syncope, epilepsy and seizures after gastric bypass surgery.
“Patients were also at increased risk for confusion, syncope, epilepsy and seizures after gastric bypass surgery (19).”
From Dumping syndrome after esophageal, gastric or bariatric surgery: Pathophysiology, diagnosis, and management (2017) · cites this paper as [19]
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- Authors
- Marsk, R., Jonas, E., Rasmussen, F., & Näslund, E.
- Affiliations
- Danderyds sjukhus (SE)
- Karolinska Institutet (SE)
- Corresponding author
- Näslund, E.
- Venue
- Diabetologia
- Published
- 2010-05-22
- Volume
- 53
- Issue
- 11
- Pages
- 2307-2311
- ISSN
- 0012-186X (ISSN-L)
- 1432-0428
- OpenAlex
- W2036282220
- Cited by
- 273
- References
- 12
- Citations by year
- 2026: 8 · 2025: 7 · 2024: 10 · 2023: 18 · 2022: 22 · 2021: 18 · 2020: 21 · 2019: 18 · 2018: 20 · 2017: 15 · 2016: 31 · 2015: 20 · 2014: 21 · 2013: 15 · 2012: 12
- FWCI
- 14.49
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- www.springer.com/tdm (tdm)
- Locations
- Diabetologia (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Karolinska Institutet
- Stockholms Läns Landsting
- Vetenskapsrådet
- Topics
- Health Sciences › Medicine › Surgery › Bariatric Surgery and Outcomes
- Health Sciences › Medicine › Surgery › Minimally Invasive Surgical Techniques
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
- Keywords
- bariatric surgery, gastric bypass, confusion, syncope, epilepsy, seizures, hospitalization, vertical banded gastroplasty, gastric banding, incidence
- MeSH terms
- Adult, Confusion, Epilepsy, Female, Humans, Hypoglycemia, Male, Middle Aged, Obesity, Postoperative Complications, Seizures, Syncope, Cohort Studies, Gastric Bypass, Gastroplasty
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Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
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