Diagnostic tools for post‐gastric bypass hypoglycaemia
Abstract
In spite of its evident success, several late complications can occur after gastric bypass surgery. One of these is post-gastric bypass hypoglycaemia. No evidence-based guidelines exist in the literature on how to confirm the presence of this syndrome. This study aims to describe and compare the tests aimed at making a diagnosis of post-gastric bypass hypoglycaemia and to provide a diagnostic approach based upon the available evidence. A search was conducted in PubMed, Cochrane and Embase. A few questionnaires have been developed to measure the severity of symptoms in post-gastric bypass hypoglycaemia but none has been validated. The gold standard for provocation of a hypoglycaemic event is the oral glucose tolerance test or the liquid mixed meal tolerance test. Both show a high prevalence of hypoglycaemia in post-gastric bypass patients with and without hypoglycaemic complaints as well as in healthy volunteers. No uniformly established cut-off values for glucose concentrations are defined in the literature for the diagnosis of post-gastric bypass hypoglycaemia. For establishing an accurate diagnosis of post-gastric bypass hypoglycaemia, a validated questionnaire, in connection with the diagnostic performance of provocation tests, is the most important thing missing. Given these shortcomings, we provide recommendations based upon the current literature.
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The diagnostic accuracy of the OGTT is low and normative values have not been firmly established.
“Therefore, the diagnostic accuracy of this test is low and normative values have not been firmly established (20).”
From Dumping syndrome after esophageal, gastric or bariatric surgery: Pathophysiology, diagnosis, and management (2017) · cites this paper as [20]
Because there is currently no optimal approach for the diagnosis of dumping syndrome, provocative testing is still commonly used in some countries to diagnose hypoglycemia in the safety of a medical testing facility.
“Because there is currently no optimal approach for the diagnosis of dumping syndrome, (20) provocative testing is still commonly used in some countries to diagnose hypoglycemia in the safety of a medical testing facility.”
From Dumping syndrome after esophageal, gastric or bariatric surgery: Pathophysiology, diagnosis, and management (2017) · cites this paper as [20]
Hypoglycemia unawareness may develop as a result of recurrent hypoglycemia, making it even more difficult to diagnose late dumping syndrome in patients who have undergone gastric bypass surgery.
“Hypoglycemia unawareness may develop as a result of recurrent hypoglycemia, making it even more difficult to diagnose late dumping syndrome in patients who have undergone gastric bypass surgery (20).”
From Dumping syndrome after esophageal, gastric or bariatric surgery: Pathophysiology, diagnosis, and management (2017) · cites this paper as [20]
The OGTT frequently detects post-gastric bypass hypoglycemia in patients with and without symptoms, as well as in healthy individuals.
“Furthermore, the OGTT frequently detects post-gastric bypass hypoglycemia in patients with and without symptoms, as well as in healthy individuals (20).”
From Dumping syndrome after esophageal, gastric or bariatric surgery: Pathophysiology, diagnosis, and management (2017) · cites this paper as [20]
Some studies demonstrate improved specificity of the mixed meal tolerance test in asymptomatic patients; however, normative values have not been established for healthy individuals.
“Some studies demonstrate improved specificity of this test in asymptomatic patients; however, normative values have not been established for healthy individuals (20).”
From Dumping syndrome after esophageal, gastric or bariatric surgery: Pathophysiology, diagnosis, and management (2017) · cites this paper as [20]
The mixed meal tolerance test holds promise as a more physiologic stimulation test for the detection of post-gastric bypass hypoglycemia.
“The mixed meal tolerance test holds promise as a more physiologic stimulation test for the detection of post-gastric bypass hypoglycemia (20,40).”
From Dumping syndrome after esophageal, gastric or bariatric surgery: Pathophysiology, diagnosis, and management (2017) · cites this paper as [20]
Cites
Effects of Bariatric Surgery on Mortality in Swedish Obese Subjects
Sjöström, L., Narbro, K., Sjöström, C. D., Karason, K., Larsson, B., Wedel, H., Lystig, T., Sullivan, M., Bouchard, C., Carlsson, B., et al. (2007) · New England Journal of Medicine · doi:10.1056/nejmoa066254 · Cited by 4,668 · see citing works
Weight and Type 2 Diabetes after Bariatric Surgery: Systematic Review and Meta-analysis
Buchwald, H., Estok, R., Fahrbach, K., Banel, D., Jensen, M. D., Pories, W. J., Bantle, J. P., & Sledge, I. (2009) · The American Journal of Medicine · doi:10.1016/j.amjmed.2008.09.041 · Cited by 2,551 · see citing works
Seaquist, E. R., Anderson, J., Childs, B., Cryer, P., Dagogo-Jack, S., Fish, L., Heller, S. R., Rodriguez, H., Rosenzweig, J., & Vigersky, R. (2013) · Diabetes Care · doi:10.2337/dc12-2480 · Cited by 1,389 · cited 1× · see citing works
“However, the accuracy of CGM in the hypoglycaemic range is poor, and trends are more important than absolute concentrations (53).”
BackgroundCryer, P. E., Axelrod, L., Grossman, A. B., Heller, S. R., Montori, V. M., Seaquist, E. R., & Service, F. J. (2009) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2008-1410 · Cited by 1,277 · cited 2× · see citing works
“Provocative testing, the mixed meal tolerance test The mixed meal tolerance test (MMTT) (Tables 2b and 3) has been developed as an alternative to the oGTT due to increased understanding that a 75 g glucose load without the addition of other macronutrients is not physiological (44).”
BackgroundMethodDonnelly, L. A., Morris, A. D., Frier, B. M., Ellis, J. D., Donnan, P. T., Durrant, R., Band, M. M., Reekie, G., & Leese, G. P. (2005) · Diabetic Medicine · doi:10.1111/j.1464-5491.2005.01501.x · Cited by 511 · 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
Arts, J., Caenepeel, P., Bisschops, R., Dewulf, D., Holvoet, L., Piessevaux, H., Bourgeois, S., Sifrim, D., Janssens, J., & Tack, J. (2009) · Clinical Gastroenterology and Hepatology · doi:10.1016/j.cgh.2008.11.025 · Cited by 142 · cited 2× · see citing works
“developed a dumping severity score in which the symptoms of early and late dumping (eight and six symptoms, respectively) were scored on a 4-point Likert scale (31).”
BackgroundSalehi, M., Gastaldelli, A., & D'Alessio, D. A. (2014) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2013-2686 · Cited by 130 · see citing works
Large-Scale Investigation into Dumping Syndrome after Gastrectomy for Gastric Cancer
Mine, S., Sano, T., Tsutsumi, K., Murakami, Y., Ehara, K., Saka, M., Hara, K., Fukagawa, T., Udagawa, H., & Katai, H. (2010) · Journal of the American College of Surgeons · doi:10.1016/j.jamcollsurg.2010.07.003 · Cited by 106 · cited 1× · see citing works
“used a questionnaire in patients after different gastric operations for ulcers and cancer (32).”
MethodRitz, P., Vaurs, C., Bertrand, M., Anduze, Y., Guillaume, E., & Hanaire, H. (2012) · Diabetes Technology & Therapeutics · doi:10.1089/dia.2011.0302 · Cited by 74 · cited 1× · see citing works
“Indeed, several investigators have used CGM systems and found that glucose variability is exaggerated after gastric bypass, that subgroups exists according hyperglycaemic pattern in these patients, and that treatment with diet and acarbose improves glycaemic excursions (54).”
BackgroundHepburn, D. A., Deary, I. J., MacLeod, K. M., & Frier, B. M. (1994) · Diabetes Care · doi:10.2337/diacare.17.11.1273 · Cited by 66 · see citing works
Mixed Meal Tolerance Test and Reactive Hypoglycemia
Buss, R., Kansal, P., Roddam, R., Pino, J., & Boshell, B. (1982) · Hormone and Metabolic Research · doi:10.1055/s-2007-1018995 · Cited by 33 · see citing works
de Heide, L. J. M., Laskewitz, A. J., & Apers, J. A. (2014) · Surgery for Obesity and Related Diseases · doi:10.1016/j.soard.2013.11.006 · Cited by 33 · cited 1× · see citing works
“In contrast to type 1 diabetes patients who have non-severe hypoglycaemic events one to two times per week (12,13), the frequency of hypoglycaemia after gastric bypass surgery in affected patients can be much higher, with episodes often occurring several times a day (14).”
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van Beek, A. P., Emous, M., Laville, M., & Tack, J. (2017) · Obesity Reviews · doi:10.1111/obr.12467 · Cited by 288 · see citing works
“Because there is currently no optimal approach for the diagnosis of dumping syndrome, (20) provocative testing is still commonly used in some countries to diagnose hypoglycemia in the safety of a medical testing facility.”
BackgroundInfluentialSelf-citationDo Gut Hormones Contribute to Weight Loss and Glycaemic Outcomes after Bariatric Surgery?
Papamargaritis, D., & le Roux, C. W. (2021) · Nutrients · doi:10.3390/nu13030762 · Cited by 68 · see citing works
Lembo, E., Lupoli, R., Ciciola, P., Creanza, A., Silvestri, E., Saldalamacchia, G., & Capaldo, B. (2018) · Nutrients · doi:10.3390/nu10060670 · Cited by 25 · see citing works
- Authors
- Emous, M., Ubels, F. L., & van Beek, A. P.
- Affiliations
- Medisch Centrum Leeuwarden (NL)
- Department of Bariatric and Metabolic Surgery Medical Center Leeuwarden Leeuwarden The Netherlands
- Corresponding author
- Emous, M.
- ORCID
- Emous, M.
- Venue
- Obesity Reviews
- Publisher
- Wiley
- Published
- 2015-08-28
- Volume
- 16
- Issue
- 10
- Pages
- 843-856
- ISSN
- 1467-7881 (ISSN-L)
- 1467-789X
- OpenAlex
- W1879425258
- Cited by
- 58
- References
- 14
- Citations by year
- 2026: 1 · 2025: 3 · 2024: 4 · 2023: 10 · 2022: 5 · 2021: 6 · 2020: 5 · 2019: 4 · 2018: 8 · 2017: 5 · 2016: 7
- FWCI
- 1.28
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Obesity Reviews (publishedVersion)
- PubMed (publishedVersion)
- University of Groningen research database (University of Groningen / Centre for Information Technology) (submittedVersion)
- Topics
- Health Sciences › Medicine › Surgery › Bariatric Surgery and Outcomes
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
- Health Sciences › Medicine › Surgery › Minimally Invasive Surgical Techniques
- Keywords
- bariatric surgery complications, diagnostic testing, oral glucose tolerance test, mixed meal tolerance test, bariatric surgery
- MeSH terms
- Dumping Syndrome, Humans, Hypoglycemia, Obesity, Morbid, Postoperative Complications, Surveys and Questionnaires, Gastric Bypass, Weight Loss, Practice Guidelines as Topic
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