Contribution of glycemic variability to hypoglycemia, and a new marker for diabetes remission after Roux-en-Y gastric bypass surgery

Jingyi Lu; Yunhui Pan; Yinfang Tu; Pin Zhang; Jian Zhou; Haoyong Yu

doi:10.1016/j.soard.2022.01.012

Contribution of glycemic variability to hypoglycemia, and a new marker for diabetes remission after Roux-en-Y gastric bypass surgery

Surg Obes Relat Dis. 2022 May;18(5):666-673. doi: 10.1016/j.soard.2022.01.012. Epub 2022 Jan 26.

Authors

Jingyi Lu¹, Yunhui Pan¹, Yinfang Tu¹, Pin Zhang², Jian Zhou¹, Haoyong Yu³

Affiliations

¹ Department of Endocrinology and Metabolism, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai Diabetes Institute, Shanghai Clinical Center of Diabetes, Shanghai Key Laboratory of Diabetes Mellitus, Shanghai Key Clinical Center for Metabolic Disease, Shanghai, China.
² Department of General Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China.
³ Department of Endocrinology and Metabolism, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai Diabetes Institute, Shanghai Clinical Center of Diabetes, Shanghai Key Laboratory of Diabetes Mellitus, Shanghai Key Clinical Center for Metabolic Disease, Shanghai, China. Electronic address: yuhaoyong111@163.com.

PMID: 35190269
DOI: 10.1016/j.soard.2022.01.012

Abstract

Background: Diabetes remission after bariatric surgery was reported to be characterized by increased risk of hypoglycemia.

Objectives: This study aimed to examine the contribution of glycemic variability (GV) to the risk of hypoglycemia, and the suitability of time in range (TIR), an emerging glycemic marker, to define diabetes remission after Roux-en-Y gastric bypass (RYGB).

Setting: A single referral center in China.

Methods: This retrospective study included 175 individuals with type 2 diabetes and obesity who underwent RYGB. Subjects were classified as remission/nonremission according to the current standard. Each participant underwent continuous glucose monitoring both before and 1 year after RYGB. GV was measured by glucose coefficient of variation (CV), and hypoglycemia was assessed by time below range (TBR).

Results: Complete remission was achieved in 88 of the 175 participants following RYGB. In the remission group, significant correlations between postoperative CV and TBRs (r = .353-.442, both P ≤ .001) were found. Excess hypoglycemia (TBR_{<54 ,} ≥1%, TBR_<70, ≥4%) increased with ascending CV quintiles (both P for trend <.05) and was significantly more frequent in subjects with glucose CV >32.2% (both P <.05). Compared with glycated hemoglobin A1C, TIR showed stronger correlation with glucose CV and risk of hypoglycemia.

Conclusion: Increased glycemic variability was linked to excess risk of hypoglycemia after RYGB. Furthermore, TIR may serve as a new metric, in addition to HbA1C, for defining diabetes remission.

Keywords: Bariatric surgery; Diabetes remission; Glycemic variability; Hypoglycemia.

MeSH terms

Biomarkers
Blood Glucose
Blood Glucose Self-Monitoring / adverse effects
Diabetes Mellitus, Type 2* / complications
Diabetes Mellitus, Type 2* / surgery
Gastric Bypass* / adverse effects
Humans
Hypoglycemia* / etiology
Retrospective Studies

Substances

Biomarkers
Blood Glucose