Incidence and Predictors of Hypoglycemia 1 Year After
Laparoscopic Sleeve Gastrectomy
Chiara Dal Pra’
Published online: 25 May 2017
Springer Science+Business Media New York 2017
Introduction Hypoglycemia is a known adverse event follow-
ing gastric bypass. The incidence of hypoglycemia after lapa-
roscopic sleeve gastrectomy (LSG) is still under investigation.
The aim of our study was to verify the presence of oral glucose
tolerance test (OGTT)-related hypoglycemia after LSG and to
identify any baseline predictors of its occurrence.
Methods We analyzed 197 consecutive non-diabetic morbid
obese patients that underwent LSG. All patients were studied
before and 12 months after LSG. Evaluation included anthro-
pometric parameters, 3-h OGTT for blood glucose (BG), in-
sulin and c-peptide, lipid profile, interleukin-6 (IL-6), tumor
necrosis factor alpha (TNF-α), highly sensitive C-reactive
protein (hsCRP), and leptin. Hypoglycemia was defined as
BG ≤ 2.7 mmol/l.
Results After surgery, 180 patients completed the OGTT.
Eleven patients did not complete the test for gastric intoler-
ance, and in six patients, the test was stopped earlier for the
onset of severe symptomatic hypoglycemia. Of the patients,
61/186 (32.8%) had at least one OGTT-related hypoglycemia.
The highest frequency of hypoglycemic events occurred 150′
after glucose load (20.2%). At baseline, patients with hypo-
glycemic events after surgery (Hypo) were younger (40 ± 11
vs 46 ± 10 years; p < 0.001), less obese (BMI 46 ± 5.7 vs
48.4 ± 7.9 kg/m
; p < 0.05), and had a worse lipid profile as
compared to patients without hypoglycemic events (N-Hypo).
Moreover, after LSG, Hypo patients compared with N-Hypo
presented a higher weight loss (%EBMIL 80 ± 20 vs
62 ± 21%; p < 0.001). Low age, low fasting glucose, and high
triglyceride levels before LSG were independent predictors of
hypoglycemia development after surgery (r
Conclusion These findings confirm the high incidence of
post-prandial hypoglycemia 1 year after LSG. Hypo
glycemia is more frequent in younger patients with lower
fasting glucose and higher triglyceride levels before surgery.
Keywords Bariatric surgery
Bariatric surgery has extensively spread in recent years, and
over 468.609 procedures were performed worldwide in 2013
. A recent systematic review concluded that bariatric sur-
gery, regardless of the type of procedure considered, leads to a
greater improvement in weight loss outcomes and weight as-
sociated co-morbidities compared with no surgical interven-
The most common bariatric procedure performed world-
wide is still Roux-en-Y gastric bypass (RYGB), but the use
of sleeve gastrectomy is increasing. Historically, laparoscopic
sleeve gastrectomy (LSG) has been proposed as the first step
of a duodenal switch procedure, but subsequently evolved to
an isolated procedure; since 2008, its prevalence markedly
increased raising from 5 to 37% of all bariatric procedures .
RYGB and LSG are comparable in terms of weight loss
outcome, co-morbidity improvement, and intra-operative and
early post-operative safety . In 2005, for the first time,
Service et al. reported cases of hypoglycemic events occurring
months to years after RYGB . Since then, an increasing
* Anna Belligoli
Center for the Study and the Integrated Management of Obesity,
University Hospital of Padova, Padova, Italy
Clinica Medica 3, Azienda Ospedaliera di Padova, Via Giustiniani 2,
35100 Padova, Italy
OBES SURG (2017) 27:3179–3186