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GLP1 analogs as treatment of postprandial hypoglycemia following gastric bypass surgery : a potential new indication?
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- Abrahamsson, Niclas (author)
- Uppsala universitet,Klinisk diabetologi och metabolism
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- Engström, Britt Edén (author)
- Uppsala universitet,Endokrinologi och mineralmetabolism
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- Sundbom, Magnus (author)
- Uppsala universitet,Gastrointestinalkirurgi
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- 2013
- 2013
- English.
- In: European Journal of Endocrinology. - 0804-4643 .- 1479-683X. ; 169:6, s. 885-889
- Journal article (peer-reviewed)
Abstract
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- Objective: The number of morbidly obese subjects submitted to bariatric surgery is rising worldwide. In a fraction of patients undergoing gastric bypass (GBP), episodes with late postprandial hypoglycemia (PPHG) develop 1-3 years after surgery. The pathogenesis of this phenomenon is not fully understood; meal-induced rapid and exaggerated increases of circulating incretins and insulin appear to be at least partially responsible. Current treatments include low-carbohydrate diets, inhibition of glucose intestinal uptake, reduction of insulin secretion with calcium channel blockers, somatostatin analogs, or diazoxide, a KATP channel opener. Even partial pancreatectomy has been advocated. In type 2 diabetes, GLP1 analogs have a well-documented effect of stabilizing glucose levels without causing hypoglycemia. Design: We explored GLP1 analogs as open treatment in five consecutive GBP cases seeking medical attention because of late postprandial hypoglycemic symptoms. Results: Glucose measured in connection with the episodes in four of the cases had been 2.7, 2.5, 1.8, and 1.6 mmol/l respectively. The patients consistently described that the analogs eliminated their symptoms, which relapsed in four of the five patients when treatment was reduced/discontinued. The drug effect was further documented in one case by repeated 24-h continuous glucose measurements. Conclusion: These open, uncontrolled observations suggest that GLP1 analogs might provide a new treatment option in patients with problems of late PPHG.
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