Mixed Meal Tolerance Test Versus Continuous Glucose Monitoring for an Effective Diagnosis of Persistent Post-Bariatric Hypoglycemia

Ramos-Levi, Ana; Marcuello, Clara; Rubio Herrera, Miguel Ángel; Matía Martín, María Del Pilar; Pérez Ferré, Natalia; Sánchez Pernaute, Andrés; Torres García, Antonio José; Calle Pascual, Alfonso Luis

Mixed Meal Tolerance Test Versus Continuous Glucose Monitoring for an Effective Diagnosis of Persistent Post-Bariatric Hypoglycemia

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jcm-12-04295.pdf (549.65 KB)

Official URL

10.3390/jcm12134295

Publication date

2023

Publisher

MPDI

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URI

https://hdl.handle.net/20.500.14352/103573

Citation

Ramos-Levi, A.M.; Rubio-Herrera, M.A.; Matía-Martín, P.; Pérez-Ferre, N.; Marcuello, C.; Sánchez-Pernaute, A.; Torres-García, A.J.; Calle-Pascual, A.L. Mixed Meal Tolerance Test Versus Continuous Glucose Monitoring for an Effective Diagnosis of Persistent Post-Bariatric Hypoglycemia. J. Clin. Med. 2023, 12, 4295. https://doi.org/10.3390/jcm12134295

Abstract

Gastric bypass determines an increase in incretin secretion and glucose excursions throughout the day and may sometimes entail the development of severe post-bariatric hypoglycemia (PBH). However, there is no consensus on the gold standard method for its diagnosis. In this study, we evaluated the usefulness of a mixed meal tolerance test (MMTT) and continuous glucose monitoring (CGM) for the diagnosis of PBH, defined as glucose levels <54 mg/dL (3.0 mmol/L). We found that hypoglycemia occurred in 60% of patients after the MMTT and in 75% during CGM, and it was predominantly asymptomatic. The MMTT confirmed the diagnosis of PBH in 88.9%of patients in whom surgery had been performed more than three years ago, in comparison to 36.4% in cases with a shorter postsurgical duration. CGM diagnosed nocturnal asymptomatic hypoglycemia in 70% of patients, and daytime postprandial hypoglycemia in 25% of cases. The mean duration of asymptomatic hypoglycemia was more than 30 min a day. Patients with ≥2% of their CGM readings with hypoglycemia exhibited a higher degree of glucose variability than those with <1% of the time in hypoglycemia. Our results show that the MMTT may be a useful dynamic test to confirm the occurrence of hypoglycemia in a large number of patients with persistent and recurrent PBH during long-term follow-up after gastric bypass. CGM, on its part, helps identify hypoglycemia in the real-world setting, especially nocturnal asymptomatic hypoglycemia, bringing to light that PBH is not always postprandial.