Postprandial hypoglycaemia after Roux-en-Y gastric bypass and the effects of acarbose, sitagliptin, verapamil, liraglutide and pasireotide

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Caroline Christfort Ohrstrom, Dorte Worm, Anna Hojager, Ditte Andersen, Jens Juul Holst, Urd Lynge Kielgast, Dorte Lindqvist Hansen

Aim To investigate the effects of acarbose, sitagliptin, verapamil, liraglutide and pasireotide on post-bariatric hypoglycaemia (PBH) after Roux-en-Y gastric bypass. Materials and methods In a randomized crossover study, 11 women who had undergone Roux-en-Y gastric bypass and had documented hypoglycaemia were each evaluated during a baseline period without treatment and during five treatment periods with the following interventions: acarbose 50 mg for 1 week, sitagliptin 100 mg for 1 week, verapamil 120 mg for 1 week, liraglutide 1.2 mg for 3 weeks and pasireotide 300 mu g as a single dose. Treatment effects were evaluated by a mixed-meal tolerance test (MMTT) and, for all treatment periods except pasireotide, by 6 days of continuous glucose monitoring (CGM). Results Treatment with acarbose and treatment with pasireotide both significantly lifted nadir glucose levels (mean +/- SEM 3.9 +/- 0.2 and 7.9 +/- 0.4 vs 3.4 +/- 0.2; P < .03) and reduced time in hypoglycaemia during the MMTTs. Acarbose reduced peak glucose levels and time in hyperglycaemia, whereas pasireotide greatly increased both variables. Acarbose and pasireotide reduced insulin and C-peptide levels, and pasireotide also diminished glucagon-like peptide-1 levels. Sitagliptin lowered nadir glucose values, while verapamil and liraglutide had no effect on hypoglycaemia. During the CGM periods, the treatments had no impact on hypoglycaemia, whereas acarbose and liraglutide reduced hyperglycaemia and glycaemic variability. Conclusions In an experimental setting, treatment with acarbose and pasireotide reduced PBH. Acarbose appears to have an overall glucose-stabilizing effect, whereas pasireotide leads to increased and sustained hyperglyca
Original languageEnglish
JournalDiabetes, Obesity and Metabolism
Volume21
Issue number9
Pages (from-to)2142-2151
ISSN1462-8902
DOIs
Publication statusPublished - 2019

    Research areas

  • bariatric surgery, clinical trial, continuous glucose monitoring, GLP-1, hypoglycaemia

ID: 226036319