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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 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]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
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“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]
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In the citing paper
“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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Cites
Lifestyle, diabetes, and cardiovascular risk factors 10 years after bariatric surgery
Sjöström, L., Lindroos, A.-K., Peltonen, M., Torgerson, J., Bouchard, C., Carlsson, B., Dahlgren, S., Larsson, B., Narbro, K., Sjöström, C. D., et al. (2004) · New England Journal of Medicine · doi:10.1056/nejmoa035622 · Cited by 4,457
Hyperinsulinemic hypoglycemia with nesidioblastosis after gastric-bypass surgery.
Service, G. J., Thompson, G. B., Service, F. J., Andrews, J. C., Collazo-Clavell, M. L., & Lloyd, R. V. (2005) · New England Journal of Medicine · doi:10.1056/nejmoa043690 · Cited by 779
Gut hormones as mediators of appetite and weight loss after Roux-en-Y gastric bypass
le Roux, C. W., Welbourn, R., Werling, M., Osborne, A., Kokkinos, A., Laurenius, A., Lönroth, H., Fändriks, L., Ghatei, M. A., Bloom, S. R., et al. (2007) · Annals of Surgery · doi:10.1097/sla.0b013e3180caa3e3 · Cited by 741 · cited 1×
“One mechanism postulated to improve diabetes after gastric bypass is an augmented incretin response; postprandial plasma concentrations of the potent incretin glucagon-like peptide-1 rise after gastric bypass [2].”
BackgroundGoldfine, A. B., Mun, E. C., Devine, E., Bernier, R., Baz-Hecht, M., Jones, D. B., Schneider, B. E., Holst, J. J., & Patti, M. E. (2007) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2007-0918 · Cited by 377
Patti, M. E., McMahon, G., Mun, E. C., Bitton, A., Holst, J. J., Goldsmith, J., Hanto, D. W., Callery, M., Arky, R., Nose, V., et al. (2005) · Diabetologia · doi:10.1007/s00125-005-1933-x · Cited by 365
Meier, J. J., Butler, A. E., Galasso, R., & Butler, P. C. (2006) · Diabetes Care · doi:10.2337/dc06-0392 · Cited by 249
Kellogg, T., Bantle, J., Leslie, D., Redmond, J., Slusarek, B. M., Swan, T., Buchwald, H., & Ikramuddin, S. (2008) · Surgery for Obesity and Related Diseases · doi:10.1016/j.soard.2008.05.005 · Cited by 215
Dumping Syndrome: Pathophysiology and Treatment
Ukleja, A. (2005) · Nutrition in Clinical Practice · doi:10.1177/0115426505020005517 · Cited by 210
Clancy, T. E., Moore, F. D., & Zinner, M. J. (2006) · Journal of Gastrointestinal Surgery · doi:10.1016/j.gassur.2006.04.008 · Cited by 133
Meier, J. J., Nauck, M. A., & Butler, P. C. (2006) · Diabetologia · doi:10.1007/s00125-005-0114-2 · Cited by 64
Cited by
Sorted by citations
Jensen, R. T., Cadiot, G., Brandi, M. L., de Herder, W. W., Kaltsas, G., Komminoth, P., Scoazec, J., Salazar, R., Sauvanet, A., & Kianmanesh, R. (2012) · Neuroendocrinology · doi:10.1159/000335591 · Cited by 615
β-Cell Failure in Type 2 Diabetes: Postulated Mechanisms and Prospects for Prevention and Treatment
Halban, P. A., Polonsky, K. S., Bowden, D. W., Hawkins, M. A., Ling, C., Mather, K. J., Powers, A. C., Rhodes, C. J., Sussel, L., & Weir, G. C. (2014) · Diabetes Care · doi:10.2337/dc14-0396 · Cited by 460
“Although studies to date have not clearly dissected changes in insulin sensitivity from changes in b-cell function, augmentedGLP-1 secretion amplifies RYGB’s antidiabetes effects on pancreatic islets (79), and post-RYGB hyperinsulinemic hypoglycemiamay involve b-cell hypertrophy or neogenesis as well (80,81).”
BackgroundGraaf, C. D., Donnelly, D., Wootten, D., Lau, J., Sexton, P. M., Miller, L. J., Ahn, J.-M., Liao, J., Fletcher, M. M., Yang, D., et al. (2016) · Pharmacological Reviews · doi:10.1124/pr.115.011395 · Cited by 403
Falkén, Y., Hellström, P. M., Holst, J. J., & Näslund, E. B. (2011) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2010-2876 · Cited by 315
Self-citationCurrent treatment paradigms and emerging therapies for NAFLD/NASH
Raza, S. (2020) · Frontiers in bioscience · doi:10.2741/4892 · Cited by 329
Metadata
- 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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