Supplementary Material for: Frequency of Hypoglycaemia after Different Bariatric Surgical Procedures

Objectives: The frequency of postprandial hypoglycaemia after different operative procedures of bariatric surgery (BS) is unknown, although this complication is potentially dangerous. Predictors and severity of hypoglycaemia after Roux-en-Y gastric bypass (RYGB), sleeve gastrectomy, and gastric banding were investigated in a large prospective study. Methods: This study was performed at an excellence centre for BS at a tertiary care institution. Data of 333 patients (mean BMI: 44.9 ± 9.6 kg/m2; mean age: 40 ± 10 years; 80.7% women) were analysed in a prospective study with a 2-year observation period after BS. All patients underwent a 2-hour oral glucose tolerance test (OGTT) with measurements of blood glucose (BG) and insulin. For the purpose of this study, hypoglycaemia was defined as a post-challenge BG Results: 72 (25.6%) of 281 patients showed post-challenge hypoglycaemia after surgery. Hypoglycaemia was different after various procedures: 32.6% of patients after RYGB, 22.6% after sleeve gastrectomy, but only 2.3% after gastric banding had hypoglycaemia. In the whole group, patients with hypoglycaemia had lost more weight (p = 0.013), had a slightly greater decrease in BMI (p = 0.037), a greater change in 2-hour post-challenge BG (p = 0.001), and a smaller change in 1-hour post-challenge insulin (p = 0.004) compared to patients without hypoglycaemia. Conclusion: This prospective study shows a higher prevalence of severe hypoglycaemia (25.6%) after BS than anticipated from retrospective registers. A systematic evaluation of glucose and insulin levels by OGTT 2 years post-surgery may help to identify patients at increased risk for symptomatic and asymptomatic hypoglycaemia.研究目的：减肥手术（bariatric surgery, BS）不同术式后的餐后低血糖发生率尚不明确，且该并发症具有潜在危险性。本大型前瞻性研究旨在探究Roux-en-Y胃旁路术（Roux-en-Y gastric bypass, RYGB）、袖状胃切除术（sleeve gastrectomy）与胃绑带术（gastric banding）术后低血糖的危险因素及严重程度。 研究方法：本研究于某三级医疗中心的减肥手术卓越中心开展。共纳入333例患者（平均体质量指数（Body Mass Index, BMI）：44.9±9.6 kg/m²；平均年龄：40±10岁；女性占比80.7%），在减肥手术后开展为期2年的前瞻性随访并对相关数据进行分析。所有受试者均接受2小时口服葡萄糖耐量试验（oral glucose tolerance test, OGTT），检测血糖（blood glucose, BG）与胰岛素水平。本研究将低血糖定义为激发试验后血糖。 研究结果：281例患者中，72例（25.6%）术后出现激发试验后低血糖。不同术式后的低血糖发生率存在差异：Roux-en-Y胃旁路术后患者低血糖发生率为32.6%，袖状胃切除术术后为22.6%，而胃绑带术术后仅为2.3%。在全部受试者中，与无低血糖患者相比，低血糖患者体重下降更显著（p=0.013），BMI降幅略高（p=0.037），激发试验后2小时血糖变化幅度更大（p=0.001），激发试验后1小时胰岛素变化幅度更小（p=0.004）。 研究结论：本前瞻性研究显示，减肥手术后严重低血糖的患病率（25.6%）高于回顾性登记研究的预期。术后2年通过口服葡萄糖耐量试验系统性评估血糖与胰岛素水平，或有助于识别出现症状性与无症状性低血糖风险升高的患者。