Patients with neuroglycopenia after gastric bypass surgery have exaggerated incretin and insulin secretory responses to a mixed meal
Abstract
CONTEXT AND OBJECTIVE: Hyperinsulinemic hypoglycemia is newly recognized as a rare but important complication after Roux-en-Y gastric bypass (GB). The etiology of the syndrome and metabolic characteristics remain incompletely understood. Recent studies suggest that levels of incretin hormones are increased after GB and may promote excessive beta-cell function and/or growth. PATIENTS AND METHODS: We performed a cross-sectional analysis of metabolic variables, in both the fasting state and after a liquid mixed-meal challenge, in four subject groups: 1) with clinically significant hypoglycemia [neuroglycopenia (NG)] after GB surgery, 2) with no symptoms of hypoglycemia at similar duration after GB surgery, 3) without GB similar to preoperative body mass index of the surgical cohorts, and 4) without GB similar to current body mass index of the surgical cohorts. RESULTS: Insulin and C-peptide after the liquid mixed meal were both higher relative to the glucose level achieved in persons after GB with NG compared with asymptomatic individuals. Glucagon, glucagon-like peptide 1, and glucose-dependent insulinotropic peptide levels were higher in both post-GB surgical groups compared with both overweight and morbidly obese persons, and glucagon-like peptide 1 was markedly higher in the group with NG. Insulin resistance, assessed by homeostasis model assessment of insulin resistance, the composite insulin sensitivity index, or adiponectin, was similar in both post-GB groups. Dumping score was also higher in both GB groups but did not discriminate between asymptomatic and symptomatic patients. Notably, the frequency of asymptomatic hypoglycemia after a liquid mixed meal was high in post-GB patients. CONCLUSION: A robust insulin secretory response was associated with postprandial hypoglycemia in patients after GB presenting with NG. Increased incretin levels may contribute to the increased insulin secretory response.
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Patients with neuroglycopenia after gastric bypass have exaggerated insulin and GLP-1 responses to meal consumption compared with asymptomatic individuals with gastric bypass.
“Affected individuals have exaggerated insulin and GLP-1 responses to meal consumption compared with asymptomatic individuals with GB (16).”
From Gastric Bypass Surgery Enhances Glucagon-Like Peptide 1–Stimulated Postprandial Insulin Secretion in Humans (2011) · cites this paper as [16]
Glucagon secretion after gastric bypass is elevated after meal ingestion.
“Previous studies have reported that glucagon secretion after GB is elevated after meal ingestion (9,16,25)”
From Gastric Bypass Surgery Enhances Glucagon-Like Peptide 1–Stimulated Postprandial Insulin Secretion in Humans (2011) · cites this paper as [16]
Glucagon secretion after gastric bypass is not altered among subjects with recurrent hypoglycemia.
“and is not altered among subjects with recurrent hypoglycemia (16).”
From Gastric Bypass Surgery Enhances Glucagon-Like Peptide 1–Stimulated Postprandial Insulin Secretion in Humans (2011) · cites this paper as [16]
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References 51 · Cited by 377
- Authors
- 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.
- Affiliations
- Brigham and Women's Hospital (US)
- Joslin Diabetes Center (US)
- Beth Israel Deaconess Medical Center (US)
- University of Copenhagen (DK)
- Corresponding author
- Goldfine, A. B.
- Venue
- The Journal of Clinical Endocrinology & Metabolism
- Publisher
- The Endocrine Society
- Published
- 2007-12-01
- Volume
- 92
- Issue
- 12
- Pages
- 4678-4685
- ISSN
- 0021-972X (ISSN-L)
- 1945-7197
- OpenAlex
- W2015020820
- Cited by
- 377
- References
- 51
- Citations by year
- 2026: 9 · 2025: 8 · 2024: 14 · 2023: 19 · 2022: 16 · 2021: 13 · 2020: 21 · 2019: 20 · 2018: 21 · 2017: 21 · 2016: 33 · 2015: 27 · 2014: 27 · 2013: 22 · 2012: 29
- FWCI
- 15.97
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- The Journal of Clinical Endocrinology & Metabolism (publishedVersion)
- PubMed (publishedVersion)
- Research at the University of Copenhagen (University of Copenhagen) (publishedVersion)
- Research at the University of Copenhagen (University of Copenhagen) (submittedVersion)
- Funders
- American Diabetes Association
- Joslin Diabetes Center
- Sundhed og Sygdom, Det Frie Forskningsråd
- Novo Nordisk
- Novo Nordisk Fonden
- National Institutes of Health (DK 36836)
- Medical Research Council
- National Institute of Diabetes and Digestive and Kidney Diseases (K23 DK 02795, K23DK002795, DK36836, DK-062948, DK70648, R01DK070648, R01DK060837, DK060837, R01DK062948, P30DK036836)
- National Center for Research Resources (M01RR001032)
- Topics
- Health Sciences › Medicine › Surgery › Bariatric Surgery and Outcomes
- Health Sciences › Medicine › Surgery › Pancreatic function and diabetes
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
- Keywords
- neuroglycopenia, Roux-en-Y gastric bypass, hyperinsulinemic hypoglycemia, incretins, insulin secretion, glucagon-like peptide-1, glucose-dependent insulinotropic polypeptide, glucagon, mixed meal tolerance, postprandial hypoglycemia, dumping syndrome, insulin resistance, bariatric surgery complications
- MeSH terms
- Adult, Aged, Blood Glucose, C-Peptide, Eating, Female, Food, Gastric Inhibitory Polypeptide, Glucagon, Humans, Hypoglycemia, Insulin, Insulin Resistance, Male, Middle Aged, Obesity, Obesity, Morbid, Postoperative Complications, Gastric Bypass, Body Mass Index, Glucagon-Like Peptide 1, Incretins
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