Continuous glucose monitoring in patients with post‐bariatric hypoglycaemia reduces hypoglycaemia and glycaemic variability
Open accessAbstract
Aim: To determine whether continuous glucose monitoring (CGM) can reduce hypoglycaemia in patients with post‐bariatric hypoglycaemia (PBH). Materials and Methods: In an open‐label, nonrandomized, pre‐post design with sequential assignment, CGM data were collected in 22 individuals with PBH in two sequential phases: (i) masked (no access to sensor glucose or alarms); and (ii) unmasked (access to sensor glucose and alarms for low or rapidly declining sensor glucose). Twelve participants wore the Dexcom G4 device for a total of 28 days, while 10 wore the Dexcom G6 device for a total of 20 days. Results: Participants with PBH spent a lower percentage of time in hypoglycaemia over 24 hours with unmasked versus masked CGM (<3.3 mM/L, or <60 mg/dL: median [median absolute deviation {MAD}] 0.7 [0.8]% vs. 1.4 [1.7]%, P = 0.03; <3.9 mM/L, or <70 mg/dL: median [MAD] 2.9 [2.5]% vs. 4.7 [4.8]%; P = 0.04), with similar trends overnight. Sensor glucose data from the unmasked phase showed a greater percentage of time spent between 3.9 and 10 mM/L (70‐180 mg/dL) (median [MAD] 94.8 [3.9]% vs. 90.8 [5.2]%; P = 0.004) and lower glycaemic variability over 24 hours (median [MAD] mean amplitude of glycaemic excursion 4.1 [0.98] vs. 4.4 [0.99] mM/L; P = 0.04). During the day, participants also spent a greater percentage of time in normoglycaemia with unmasked CGM (median [MAD] 94.2 [4.8]% vs. 90.9 [6.2]%; P = 0.005), largely due to a reduction in hyperglycaemia (>10 mM/L, or 180 mg/dL: median [MAD] 1.9 [2.2]% vs. 3.9 [3.6]%; P = 0.02). Conclusions: Real‐time CGM data and alarms are associated with reductions in low sensor glucose, elevated sensor glucose, and glycaemic variability. This suggests CGM allows patients to detect hyperglycaemic peaks and imminent hypoglycaemia, allowing dietary modification and self‐treatment to reduce hypoglycaemia. The use of CGM devices may improve safety in PBH, particularly for patients with hypoglycaemia unawareness.
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CGM may also be helpful to reduce hypoglycemia and improve quality of life in people with hypoglycemia as a complication of metabolic surgery.
“CGM may also be helpful to reduce hypoglycemia and improve quality of life in people with hypoglycemia as a complication of metabolic surgery (152,153).”
From 6. Glycemic Goals, Hypoglycemia, and Hyperglycemic Crises: Standards of Care in Diabetes-2026. (2026) · cites this paper as [152]
The Discussion reports that CGM reduced hypoglycaemia in patients with post-bariatric hypoglycaemia. It also says that further studies are needed to determine its impact on quality of life in these patients, so the quality-of-life part is not established by this paper. (LLM, conf=0.88)
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Cites
Long-term mortality after gastric bypass surgery
Adams, T. D., Gress, R. E., Smith, S. C., Halverson, R. C., Simper, S. C., Rosamond, W. D., LaMonte, M. J., Stroup, A. M., & Hunt, S. C. (2007) · New England Journal of Medicine · doi:10.1056/nejmoa066603 · Cited by 2,572 · see citing works
Continuous glucose monitoring and metrics for clinical trials: an international consensus statement
Battelino, T., Alexander, C. M., Amiel, S. A., Arreaza-Rubin, G., Beck, R. W., Bergenstal, R. M., Buckingham, B. A., Carroll, J., Ceriello, A., Chow, E., et al. (2023) · The Lancet Diabetes & Endocrinology · doi:10.1016/s2213-8587(22)00319-9 · Cited by 831 · see citing works
Gold, A. E., Macleod, K. M., & Frier, B. M. (1994) · Diabetes Care · doi:10.2337/diacare.17.7.697 · Cited by 810 · see citing works
Clarke, W. L., Cox, D. J., Gonder-Frederick, L. A., Julian, D., Schlundt, D., & Polonsky, W. (1995) · Diabetes Care · doi:10.2337/diacare.18.4.517 · Cited by 651 · see citing works
Fear of hypoglycemia: quantification, validation, and utilization
Cox, D. J., Irvine, A., Gonder-Frederick, L., Nowacek, G., & Butterfield, J. (1987) · Diabetes Care · doi:10.2337/diacare.10.5.617 · Cited by 579 · see citing works
Mingrone, G., Panunzi, S., De Gaetano, A., Guidone, C., Iaconelli, A., Capristo, E., Chamseddine, G., Bornstein, S. R., & Rubino, F. (2021) · The Lancet · doi:10.1016/s0140-6736(20)32649-0 · Cited by 577 · see citing works
Relation between body mass index and cognitive function in healthy middle-aged men and women
Cournot, M., Marquié, J. C., Ansiau, D., Martinaud, C., Fonds, H., Ferrières, J., & Ruidavets, J. B. (2006) · Neurology · doi:10.1212/01.wnl.0000238082.13860.50 · Cited by 517 · see citing works
Goldfine, 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 · see citing works
Self-citationPolonsky, W. H., Hessler, D., Ruedy, K. J., & Beck, R. W. (2017) · Diabetes Care · doi:10.2337/dc17-0133 · Cited by 346 · see citing works
Salehi, M., Prigeon, R. L., & D’Alessio, D. A. (2011) · Diabetes · doi:10.2337/db11-0203 · Cited by 323 · see citing works
Shah, V. N., DuBose, S. N., Li, Z., Beck, R. W., Peters, A. L., Weinstock, R. S., Kruger, D., Tansey, M., Sparling, D., Woerner, S., et al. (2019) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2018-02763 · Cited by 315 · see citing works
Fisher, D. P., Johnson, E., Haneuse, S., Arterburn, D., Coleman, K. J., O’Connor, P. J., O’Brien, R., Bogart, A., Theis, M. K., Anau, J., et al. (2018) · JAMA · doi:10.1001/jama.2018.14619 · Cited by 305 · see citing works
Partitioning the symptoms of hypoglycaemia using multi-sample confirmatory factor analysis
Deary, I. J., Hepburn, D. A., MacLeod, K. M., & Frier, B. M. (1993) · Diabetologia · doi:10.1007/bf00401150 · Cited by 286 · see citing works
Marsk, R., Jonas, E., Rasmussen, F., & Näslund, E. (2010) · Diabetologia · doi:10.1007/s00125-010-1798-5 · Cited by 273 · see citing works
International consensus on the diagnosis and management of dumping syndrome
Scarpellini, E., Arts, J., Karamanolis, G., Laurenius, A., Siquini, W., Suzuki, H., Ukleja, A., van Beek, A. V., Vanuytsel, T., Bor, S., et al. (2020) · Nature Reviews Endocrinology · doi:10.1038/s41574-020-0357-5 · Cited by 247 · see citing works
Hypoglycemia After Gastric Bypass Surgery: Current Concepts and Controversies
Salehi, M., Vella, A., McLaughlin, T., & Patti, M.-E. (2018) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2018-00528 · Cited by 239 · see citing works
Self-citationInduction of Hypoglycemia Unawareness by Asymptomatic Nocturnal Hypoglycemia
Veneman, T. F., Mitrakou, A., Mokáň, M., Cryer, P., & Gerich, J. E. (1993) · Diabetes · doi:10.2337/diab.42.9.1233 · Cited by 211 · see citing works
Doumouras, A. G., Wong, J. A., Paterson, J. M., Lee, Y., Sivapathasundaram, B., Tarride, J.-E., Thabane, L., Hong, D., Yusuf, S., & Anvari, M. (2021) · Circulation · doi:10.1161/circulationaha.120.052386 · Cited by 209 · see citing works
Wadwa, R. P., Laffel, L. M., Shah, V. N., & Garg, S. K. (2018) · Diabetes Technology & Therapeutics · doi:10.1089/dia.2018.0150 · Cited by 197 · see citing works
Shah, V. N., Laffel, L. M., Wadwa, R. P., & Garg, S. K. (2018) · Diabetes Technology & Therapeutics · doi:10.1089/dia.2018.0143 · Cited by 197 · see citing works
Sleep-Related Hypoglycemia-Associated Autonomic Failure in Type 1 Diabetes
Banarer, S., & Cryer, P. E. (2003) · Diabetes · doi:10.2337/diabetes.52.5.1195 · Cited by 186 · see citing works
Lee, C. J., Clark, J. M., Schweitzer, M., Magnuson, T., Steele, K., Koerner, O., & Brown, T. T. (2015) · Obesity · doi:10.1002/oby.21042 · Cited by 159 · see citing works
Kefurt, R., Langer, F., Schindler, K., Shakeri-Leidenmühler, S., Ludvik, B., & Prager, G. (2015) · Surgery for Obesity and Related Diseases · doi:10.1016/j.soard.2014.11.003 · Cited by 143 · see citing works
Kirwan, J. P., Courcoulas, A. P., Cummings, D. E., Goldfine, A. B., Kashyap, S. R., Simonson, D. C., Arterburn, D. E., GOURASH, W. F., Vernon, A. H., Jakicic, J. M., et al. (2022) · Diabetes Care · doi:10.2337/dc21-2441 · Cited by 129 · see citing works
Self-citationNguyen, N. Q., Debreceni, T. L., Bambrick, J. E., Bellon, M., Wishart, J. M., Standfield, S., Rayner, C. K., & Horowitz, M. (2014) · Obesity · doi:10.1002/oby.20791 · Cited by 118 · see citing works
Interpreting blood GLUcose data with R package iglu
Broll, S., Urbanek, J., Buchanan, D., Chun, E., Muschelli, J., Punjabi, N., & Gaynanova, I. (2020) · bioRxiv · doi:10.1371/journal.pone.0248560 · Cited by 102 · see citing works
Susceptibility of Interstitial Continuous Glucose Monitor Performance to Sleeping Position
Mensh, B. D., Wisniewski, N. A., Neil, B. M., & Burnett, D. R. (2013) · Journal of Diabetes Science and Technology · doi:10.1177/193229681300700408 · Cited by 97 · see citing works
Medical Nutrition Therapy for Post-Bariatric Hypoglycemia: Practical Insights
Suhl, E., Anderson-Haynes, S.-E., Mulla, C., & Patti, M.-E. (2017) · Surgery for Obesity and Related Diseases · doi:10.1016/j.soard.2017.01.025 · Cited by 96 · see citing works
Self-citationOutcomes in bariatric and metabolic surgery: an updated 5-year review
Roth, A. E., Thornley, C. J., & Blackstone, R. P. (2020) · Current Obesity Reports · doi:10.1007/s13679-020-00389-8 · Cited by 96 · see citing works
Gastric Bypass Reduces Symptoms and Hormonal Responses in Hypoglycemia
Abrahamsson, N., Lau, J., Sundbom, M., Wiklund, U., Karlsson, F. A., & Eriksson, J. W. (2016) · Diabetes · doi:10.2337/db16-0341 · Cited by 92 · see citing works
Hypoglycemia after Roux-en-Y Gastric Bypass: The BOLD Experience
Sarwar, H., Chapman, W. H. I., Pender, J., Ivanescu, A., Drake, A. J. I., Pories, W., & Dar, M. (2014) · Obesity Surgery · doi:10.1007/s11695-014-1260-8 · Cited by 87 · see citing works
Gilbert, T. R., Noar, A., Blalock, O., & Polonsky, W. H. (2021) · Diabetes Technology & Therapeutics · doi:10.1089/dia.2020.0666 · Cited by 84 · see citing works
Dumping Syndrome Following Gastric Bypass: Validation of the Dumping Symptom Rating Scale
Laurenius, A., Olbers, T., Näslund, I., & Karlsson, J. (2013) · Obesity Surgery · doi:10.1007/s11695-012-0856-0 · Cited by 83 · see citing works
Lin, Y. K., Hung, M., Sharma, A. R., Chan, O. T. M., Varner, M. W., Staskus, G., & Fisher, S. J. (2019) · Endocrine Practice · doi:10.4158/ep-2018-0527 · Cited by 81 · see citing works
Øhrstrøm, C. C., Worm, D., Højager, A., Andersen, D., Holst, J. J., Kielgast, U. L., & Hansen, D. L. (2019) · Diabetes, Obesity and Metabolism · doi:10.1111/dom.13796 · Cited by 72 · see citing works
Hermanns, N., Heinemann, L., Freckmann, G., Waldenmaier, D., & Ehrmann, D. (2019) · Journal of Diabetes Science and Technology · doi:10.1177/1932296819831695 · Cited by 66 · see citing works
Purnell, J. Q., Dewey, E. N., Laferrère, B., Selzer, F., Flum, D. R., Mitchell, J. E., Pomp, A., Pories, W. J., Inge, T. H., Courcoulas, A. P., et al. (2020) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/clinem/dgaa849 · Cited by 66 · see citing works
Nana, M., Moore, S. L., Ang, E., Lee, Z. X., & Bondugulapati, L. N. R. (2019) · Diabetes Research and Clinical Practice · doi:10.1016/j.diabres.2019.107893 · Cited by 58 · see citing works
Plasma FGF-19 Levels are Increased in Patients with Post-Bariatric Hypoglycemia
Mulla, C. M., Goldfine, A. B., Dreyfuss, J. M., Houten, S. M., Pan, H., POBER, D. M., Albrechtsen, N. J. W., Svane, M. S., Schmidt, J. B., Holst, J. J., et al. (2019) · Obesity Surgery · doi:10.1007/s11695-019-03845-0 · Cited by 56 · see citing works
Self-citationGonzález-González, A., Delgado, M., & Fraga-Fuentes, M. (2013) · Surgery for Obesity and Related Diseases · doi:10.1016/j.soard.2011.05.010 · Cited by 50 · see citing works
Hypoglycemia: New Definitions and Regulatory Implications
Ratner, R. E. (2018) · Diabetes Technology & Therapeutics · doi:10.1089/dia.2018.0113 · Cited by 50 · see citing works
Lee, C. J., Brown, T. T., Schweitzer, M., Magnuson, T., & Clark, J. M. (2018) · Surgery for Obesity and Related Diseases · doi:10.1016/j.soard.2018.01.028 · Cited by 49 · see citing works
Moscardó, V., Giménez, M., Oliver, N. S., et al. (2020) · Diabetes Technology & Therapeutics · doi:10.1089/dia.2019.0416 · Cited by 49 · see citing works
Postoperative surveillance and detection of postprandial hypoglycemia after fundoplasty in children
Calabria, A. C., Gallagher, P. R., Simmons, R., Blinman, T., & De León, D. D. (2011) · The Journal of Pediatrics · doi:10.1016/j.jpeds.2011.03.049 · Cited by 46 · see citing works
Glycemic Patterns Are Distinct in Post-Bariatric Hypoglycemia After Gastric Bypass (PBH-RYGB)
Lee, D., Dreyfuss, J. M., Sheehan, A., Puleio, A., Mulla, C. M., & Patti, M. E. (2021) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/clinem/dgab323 · Cited by 45 · see citing works
Self-citationHendrieckx, C., Hagger, V. L., Jenkins, A. J., Skinner, T. C., Pouwer, F., & Speight, J. (2016) · Journal of Diabetes and its Complications · doi:10.1016/j.jdiacomp.2016.11.013 · Cited by 38 · see citing works
Lin, Y. K., Groat, D., Chan, O. T. M., Hung, M., Sharma, A. R., Varner, M. W., Gouripeddi, R., Facelli, J. C., & Fisher, S. J. (2020) · Diabetes Technology & Therapeutics · doi:10.1089/dia.2020.0016 · Cited by 38 · see citing works
van den Broek, M., de Heide, L. J. M., Sips, F. L. P., Koehorst, M., van Zutphen, T., Emous, M., van Faassen, M. H. J. R., Groen, A. K., van Riel, N. A. W., de Boer, J. F., et al. (2021) · International Journal of Obesity · doi:10.1038/s41366-020-00726-w · Cited by 38 · see citing works
Fischer, L. E., Wolfe, B. M., Fino, N., Elman, M. R., Flum, D. R., Mitchell, J. E., Pomp, A., Pories, W. J., Purnell, J. Q., Patti, M.-E., et al. (2021) · Surgery for Obesity and Related Diseases · doi:10.1016/j.soard.2021.04.021 · Cited by 36 · see citing works
Self-citationDiazoxide for the treatment of hypoglycaemic dumping syndrome
Thondam, S. K., Nair, S., Wile, D. B., & Gill, G. V. (2011) · QJM · doi:10.1093/qjmed/hcr234 · Cited by 35 · see citing works
Hypoglycemia Following Bariatric Surgery: Our 31-Year Experience
Michaels, A. D., Mehaffey, J. H., French, W. B., Schirmer, B. D., Kirby, J. L., & Hallowell, P. T. (2017) · Obesity Surgery · doi:10.1007/s11695-017-2734-2 · Cited by 34 · see citing works
Postprandial hypoglycemia after Nissen fundoplication for reflux esophagitis.
Zaloga, G., & Chernow, B. (1983) · Gastroenterology · doi:10.1016/0016-5085(83)90155-5 · Cited by 33 · see citing works
Denham, D. (2021) · Journal of Diabetes Science and Technology · doi:10.1177/1932296820948544 · Cited by 28 · see citing works
The hypoglycaemia error grid: A UK-wide consensus on CGM accuracy assessment in hyperinsulinism
Worth, C., Dunne, M. J., Salomon‐Estebanez, M., Harper, S., Nutter, P. W., Dastamani, A., Senniappan, S., & Banerjee, I. (2022) · Frontiers in Endocrinology · doi:10.3389/fendo.2022.1016072 · Cited by 26 · see citing works
Furth, A. V., van den Broek, M., Emous, M., de Heide, L. D., Kuipers, F., & van Beek, A. V. (2020) · Surgery for Obesity and Related Diseases · doi:10.1016/j.soard.2020.08.009 · Cited by 24 · see citing works
Octreotide improves early dumping syndrome potentially through incretins: a case report
Sato, D., Morino, K., Ohashi, N., Ueda, E., Ikeda, K., Yamamoto, H., Ugi, S., Yamamoto, H., Araki, S., & Maegawa, H. (2013) · Endocrine Journal · doi:10.1507/endocrj.ej12-0288 · Cited by 21 · see citing works
Salehi, M., Gastaldelli, A., & DeFronzo, R. A. (2022) · Metabolism · doi:10.1016/j.metabol.2022.155199 · Cited by 21 · see citing works
A New Analysis Tool for Continuous Glucose Monitor Data
OLAWSKY, E. A., Zhang, Y., Eberly, L. E., Helgeson, E. S., & Chow, L. S. (2021) · Journal of Diabetes Science and Technology · doi:10.1177/19322968211028909 · Cited by 18 · see citing works
Counterregulatory responses to postprandial hypoglycemia after Roux-en-Y gastric bypass
Øhrstrøm, C. C., Hansen, D. L., Kielgast, U. L., Bergmann, M., Veedfald, S., Holst, J. J., & Worm, D. (2020) · Surgery for Obesity and Related Diseases · doi:10.1016/j.soard.2020.08.037 · Cited by 16 · see citing works
Post-Fundoplication Dumping Syndrome: A Frequent “Rare” Complication
Kataria, R. D., Linn, S., Malik, Z. A., et al. (2018) · ACG Case Reports Journal · doi:10.14309/crj.2018.1 · Cited by 14 · see citing works
Potential contribution of the gut microbiota to hypoglycemia after gastric bypass surgery
Zhou, L., Deng, M., & Xiao, X. (2020) · Chinese Medical Journal · doi:10.1097/cm9.0000000000000932 · Cited by 10 · see citing works
Honka, H., Chuang, J., D’Alessio, D. A., & Salehi, M. (2021) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/clinem/dgab913 · Cited by 6 · see citing works
Zekarias, K., Moheet, A. A., Kumar, A. F., et al. (2018) · Diabetes · doi:10.2337/db18-2175-pub · Cited by 3 · see citing works
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6. Glycemic Goals, Hypoglycemia, and Hyperglycemic Crises: Standards of Care in Diabetes-2026.
American Diabetes Association Professional Practice Committee for Diabetes*, Bajaj, M., McCoy, R. G., Balapattabi, K., Bannuru, R. R., Bellini, N. J., Bennett, A. K., Beverly, E. A., Briggs Early, K., ChallaSivaKanaka, S., et al. (2026) · Diabetes Care · doi:10.2337/dc26-s006 · Cited by 172 · see citing works
Turk, N., Ramanujan, S., Shamloo, T., Craig, C., & McLaughlin, T. (2025) · Journal of the Endocrine Society · doi:10.1210/jendso/bvaf106 · Cited by 7 · see citing works
- Authors
- Cummings, C., Jiang, A., Sheehan, A., Ferraz‐Bannitz, R., Puleio, A., Simonson, D. C., Dreyfuss, J. M., & Patti, M. E.
- Affiliations
- Joslin Diabetes Center (US)
- Research Division, Joslin Diabetes Center Boston Massachusetts USA
- Brigham and Women's Hospital (US)
- Corresponding author
- Patti, Mary Elizabeth
- ORCID
- Venue
- Diabetes, Obesity and Metabolism
- Publisher
- Wiley
- Published
- 2023-05-03
- Volume
- 25
- Issue
- 8
- Pages
- 2191-2202
- ISSN
- 1462-8902 (ISSN-L)
- 1463-1326
- PMC
- PMC10807851
- OpenAlex
- W4365442959
- Semantic Scholar
- 808f1b1c32bc261e5c350e2480522b27e1ed3467
- Cited by
- 27
- References
- 63
- Citations by year
- 2026: 7 · 2025: 14 · 2024: 5 · 2023: 1
- FWCI
- 5.51
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Diabetes Obesity and Metabolism (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- Dexcom
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
- Health Sciences › Medicine › Surgery › Bariatric Surgery and Outcomes
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
- Keywords
- continuous glucose monitoring, hypoglycemia, glycemic variability, bariatric surgery, hyperglycemia, normoglycemia, Dexcom G6, time in range
- MeSH terms
- Blood Glucose, Diabetes Mellitus, Type 1, Humans, Hypoglycemia, Blood Glucose Self-Monitoring, Bariatrics
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