Mixed meal test detects Gastric Bypass related Hypoglycemia Better than CGM

Gastric bypass surgery increases the postprandial glucose levels, which in turn can predispose to the late complication of hypoglycemia. Diagnosis remains difficult and requires documentation of symptoms associated with hypoglycemia and relief of symptoms when blood glucose normalizes (Whipple triad). In this present study, Dr Marzieh Salehi and her team conducted a study to compare the yield of a mixed meal test and continuous glucose monitoring system in detecting hypoglycemia after gastric bypass.

The researchers conducted a study at the General Clinical Research Unit, Cincinnati Children's Hospital, USA. They evaluated the glucose profiles of 15 patients with documented recurrent clinical hypoglycemia after gastric bypass, 8 matched asymptomatic GB patients and 9 healthy weight-matched nonoperated controls. The patients were subjected to MMT in a controlled setting followed by wearing a CGM for 4 to 5 days.

Key findings of the study:

• Upon analysis, the researchers found that the patients with prior GB had larger glucose variability during both MMT and CGMS when compared with nonsurgical controls regardless of their hypoglycemic status.
• They also found that MMT was superior to CGM use in detecting post-prandial hypoglycemia, with greater sensitivity (71%) and specificity (100%) compared with CGM (47% and 88%, respectively).

The authors concluded, "Our findings indicate that a fixed carbohydrate ingestion during MMT is a more reliable test to diagnose GB-related hypoglycemia compared with CGMS during free-living state."

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DOI: https://doi.org/10.1210/clinem/dgab913