• Violeta Raverdy, Gregory Baud, Marie Pigeyre, Helene Verkindt, Fanelly Torres, Cristian Preda, Dorothee Thuillier, Patrick Gélé, Marie-Christine Vantyghem, Robert Caiazzo, and François Pattou.
• *Univ Lille, Inserm U1190 Translational Research in diabetes, Lille, 59000 France†Department CHU Lille, Lille University Hospital, Lille, France‡Department of Biostatistics, Univ Lille, CHU Lille, EA2694, Lille, France.
• Ann. Surg. 2016 Nov 1; 264 (5): 878-885.

BackgroundPostprandial hyperinsulinemic hypoglycemia (PHH) is often reported after Roux-en-Y gastric bypass (RYGB). In the absence of a prospective study, the clinical and biological determinants of PHH remain unclear.ObjectiveTo determine the incidence and predictive factors of PHH after RYGB.MethodsParticipants were 957 RYGB patients enrolled in an ongoing longitudinal cohort study. We analyzed the results of an oral glucose tolerance test (OGTT) routinely performed before surgery and 1 and/or 5 years after. PHH was defined as blood glucose < 50 mg/dL AND plasma insulin > 3 mU/L at 120 minutes post glucose challenge. Validated indices of insulin sensitivity (Matsuda index), beta-cell function (Insulinogenic index), and beta-cell mass (fasting C-peptide: glucose ratio) were calculated, from glucose, insulin, and c-peptide values measured during OGTT.ResultsOGTT results were available in all patients at baseline, in 85.6% at 12 months and 52.8% at 60 months. The incidence of PHH was 0.5% at baseline, 9.1% * and 7.9%* at 12 months and 60 months following RYGB (*: P < 0.001). In multivariate logistic regression analysis, PHH after RYGB was independently associated with lower age (P = 0.005), greater weight loss (P = 0.031), as well as higher beta-cell function (P = 0.002) and insulin sensitivity (P < 0.001), but not with beta-cell mass (P = 0.381). A preoperative elevated beta-cell function was an independent predictor of PHH after RYGB (receiver operating characteristics curve area under the curve 0.68, P = 0.04).Conclusions:The incidence of PHH significantly increased after RYGB but remained stable between 1 and 5 years. The estimation of beta-cell function with an OGTT before surgery can identify patients at risk for developing PHH after RYGB.

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