Utility of Continuous Glucose Monitoring vs. Meal Study in Detecting Hypoglycemia After Gastric Bypass

Abstract Context Gastric bypass (GB) increases postprandial glucose excursion, which in turn can predispose to the late complication of hypoglycemia. Diagnosis remains challenging and requires documentation of symptoms associated with low glucose, and relief of symptom when glucose is normalized (Whipple’s triad). Objective To compare the yield of mixed meal test (MMT) and continuous glucose monitoring system (CGMS) in detecting hypoglycemia after gastric bypass surgery (GB). Setting The study was conducted at General Clinical Research Unit, Cincinnati Children’s Hospital (Cincinnati, OH, United States). Methods Glucose profiles were evaluated in 15 patients with documented recurrent clinical hypoglycemia after GB, 8 matched asymptomatic GB subjects, and 9 healthy weight-matched non-operated controls using MMT in a control setting and CGMS under free-living conditions. Results Patients with prior GB had larger glucose variability during both MMT and CGMS when compared to non-surgical controls regardless of their hypoglycemic status. Sensitivity (71 vs. 47 %) and specificity (100 vs. 88 %) of MMT in detecting hypoglycemia was superior to CGMS. Conclusions Our findings indicate that a fixed carbohydrate ingestion during MMT is a more reliable test to diagnose GB-related hypoglycemia compared to CGMS during free-living state.

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Continuous Glucose Monitoring After Gastric Bypass to Evaluate the Glucose Variability After a Low-Carbohydrate Diet and to Determine Hypoglycemia

Obesity Surgery ◽

10.1007/s11695-016-2058-7 ◽

2016 ◽

Vol 26 (9) ◽

pp. 2111-2118 ◽

Cited By ~ 16

Author(s):

Joan Bach Nielsen ◽

Caroline Bruun Abild ◽

Ane Mathilde Pedersen ◽

Steen Bønløkke Pedersen ◽

Bjørn Richelsen

Keyword(s):

Gastric Bypass ◽

Continuous Glucose Monitoring ◽

Glucose Monitoring ◽

Glucose Variability ◽

Carbohydrate Diet ◽

Low Carbohydrate Diet ◽

Low Carbohydrate

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Initial increase in glucose variability during Ramadan fasting in non-insulin-treated patients with diabetes type 2 using continuous glucose monitoring

Libyan Journal of Medicine ◽

10.1080/19932820.2018.1535747 ◽

2018 ◽

Vol 14 (1) ◽

pp. 1535747 ◽

Cited By ~ 3

Author(s):

Nesreen Aldawi ◽

Gassan Darwiche ◽

Salah Abusnana ◽

Murtada Elbagir ◽

Targ Elgzyri

Keyword(s):

Continuous Glucose Monitoring ◽

Glucose Monitoring ◽

Diabetes Type 2 ◽

Glucose Variability ◽

Diabetes Type ◽

Initial Increase ◽

Ramadan Fasting ◽

Patients With Diabetes

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Continuous glucose monitoring use and glucose variability in pre-school children with type 1 diabetes

Diabetes Research and Clinical Practice ◽

10.1016/j.diabres.2018.10.005 ◽

2019 ◽

Vol 147 ◽

pp. 76-80 ◽

Cited By ~ 7

Author(s):

Klemen Dovc ◽

Kevin Cargnelutti ◽

Anze Sturm ◽

Julij Selb ◽

Natasa Bratina ◽

...

Keyword(s):

Type 1 Diabetes ◽

Continuous Glucose Monitoring ◽

School Children ◽

Glucose Monitoring ◽

Glucose Variability

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Lower Glucose Variability and Hypoglycemia Measured by Continuous Glucose Monitoring With Novel Long-Acting Insulin LY2605541 Versus Insulin Glargine

Diabetes Care ◽

10.2337/dc12-2621 ◽

2013 ◽

Vol 37 (3) ◽

pp. 659-665 ◽

Cited By ~ 22

Author(s):

Richard M. Bergenstal ◽

Julio Rosenstock ◽

Edward J. Bastyr ◽

Melvin J. Prince ◽

Yongming Qu ◽

...

Keyword(s):

Insulin Glargine ◽

Continuous Glucose Monitoring ◽

Glucose Monitoring ◽

Glucose Variability ◽

Acting Insulin ◽

Lower Glucose ◽

Long Acting

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Assessment of Hyperglycemia, Hypoglycemia and Inter-Day Glucose Variability Using Continuous Glucose Monitoring among Diabetic Patients on Chronic Hemodialysis

Journal of Clinical Medicine ◽

10.3390/jcm10184116 ◽

2021 ◽

Vol 10 (18) ◽

pp. 4116

Author(s):

Maria Divani ◽

Panagiotis I. Georgianos ◽

Triantafyllos Didangelos ◽

Vassilios Liakopoulos ◽

Kali Makedou ◽

...

Keyword(s):

Continuous Glucose Monitoring ◽

Glycated Albumin ◽

Glucose Monitoring ◽

Area Under The Curve ◽

Glucose Variability ◽

Hemodialysis Patients ◽

Chronic Hemodialysis ◽

Diabetic Patients ◽

Lower Efficiency ◽

Target Glucose

Continuous glucose monitoring (CGM) facilitates the assessment of short-term glucose variability and identification of acute excursions of hyper- and hypo-glycemia. Among 37 diabetic hemodialysis patients who underwent 7-day CGM with the iPRO2 device (Medtronic Diabetes, Northridge, CA, USA), we explored the accuracy of glycated albumin (GA) and hemoglobin A1c (HbA1c) in assessing glycemic control, using CGM-derived metrics as the reference standard. In receiver operating characteristic (ROC) analysis, the area under the curve (AUC) in diagnosing a time in the target glucose range of 70–180 mg/dL (TIR70–180) in <50% of readings was higher for GA (AUC: 0.878; 95% confidence interval (CI): 0.728–0.962) as compared to HbA1c (AUC: 0.682; 95% CI: 0.508–0.825) (p < 0.01). The accuracy of GA (AUC: 0.939; 95% CI: 0.808–0.991) in detecting a time above the target glucose range > 250 mg/dL (TAR>250) in >10% of readings did not differ from that of HbA1c (AUC: 0.854; 95% CI: 0.699–0.948) (p = 0.16). GA (AUC: 0.712; 95% CI: 0.539–0.848) and HbA1c (AUC: 0.740; 95% CI: 0.570–0.870) had a similarly lower efficiency in detecting a time below target glucose range < 70 mg/dL (TBR<70) in >1% of readings (p = 0.71). Although the mean glucose levels were similar, the coefficient of variation of glucose recordings (39.2 ± 17.3% vs. 32.0 ± 7.8%, p < 0.001) and TBR<70 (median (range): 5.6% (0, 25.8) vs. 2.8% (0, 17.9)) were higher during the dialysis-on than during the dialysis-off day. In conclusion, the present study shows that among diabetic hemodialysis patients, GA had higher accuracy than HbA1c in detecting a 7-day CGM-derived TIR70–180 < 50%. However, both biomarkers provided an imprecise reflection of acute excursions of hypoglycemia and inter-day glucose variability.

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Relationship of Glucose Variability and Daily Lifestyle by Continuous Glucose Monitoring (CGM)

Asploro Journal of Biomedical and Clinical Case Reports ◽

10.36502/2020/asjbccr.6213 ◽

2020 ◽

Vol 3 (3) ◽

pp. 206-212

Author(s):

Yamashita H ◽

Kato Y ◽

Bando H ◽

Kanazawa S ◽

Tanaka M ◽

...

Keyword(s):

Continuous Glucose Monitoring ◽

Glucose Monitoring ◽

Glucose Variability ◽

Future Research ◽

Low Carbohydrate Diet ◽

Freestyle Libre ◽

Low Carbohydrate ◽

Working Day ◽

Multiple Daily Insulin Injections ◽

Relationship Of

Authors and collaborators have continued diabetic practice and research on low carbohydrate diet (LCD), continuous glucose monitoring (CGM), and so on. The case is a 64-year-old male with type 2 diabetes mellitus (T2DM) treated with multiple daily insulin injections (MDI). When his HbA1c was 8.2% before, he changed to take tofu instead of rice and bread. HbA1c decreased to 7.1% and 4kg of weight reduction in 2 months. Tofu is a traditional Japanese food made from soybeans, which is a suitable LCD with Protein:Fat:Carbohydrate (PFC) ratio=40:45:15 in this case. His HbA1c is recently unstable, then glucose variability was investigated by CGM using FreeStyle Libre. The glucose pattern was different due to his lifestyle, including working day, off day, playing golf, respectively. The average glucose was 143-167 mg/dL and the estimated HbA1c was 7.1%, whereas HbA1c in outclinic was 8.1%, respectively. This report will hopefully become reference data for future research.

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What is the Role of Self-Monitoring in Diabetes? Is there a Role for Postprandial Glucose Monitoring? How does Continuous Glucose Monitoring Integrate into Clinical Practice?

Clinical Dilemmas in Diabetes ◽

10.1002/9781444340280.ch5 ◽

2011 ◽

pp. 41-55

Author(s):

Rami Almokayyad ◽

Robert Cuddihy

Keyword(s):

Clinical Practice ◽

Continuous Glucose Monitoring ◽

Glucose Monitoring ◽

Postprandial Glucose ◽

Self Monitoring

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Mechanisms of action of a carbohydrate-reduced, high-protein diet in reducing the risk of postprandial hypoglycemia after Roux-en-Y gastric bypass surgery

American Journal of Clinical Nutrition ◽

10.1093/ajcn/nqy310 ◽

2019 ◽

Vol 110 (2) ◽

pp. 296-304 ◽

Cited By ~ 3

Author(s):

Daniel Kandel ◽

Kirstine Nyvold Bojsen-Møller ◽

Maria Saur Svane ◽

Amirsalar Samkani ◽

Arne Astrup ◽

...

Keyword(s):

Gastric Bypass ◽

Insulin Secretion ◽

Cell Function ◽

Gastric Bypass Surgery ◽

High Protein Diet ◽

Glucagon Secretion ◽

Glucose Variability ◽

High Protein ◽

Β Cell Function ◽

Glucagon Like Peptide 1

ABSTRACT Background Postprandial hypoglycemia is a risk after Roux-en-Y gastric bypass (RYGB). Objectives We speculated that a carbohydrate-reduced, high-protein (CRHP) diet might reduce the risk of hypoglycemia and therefore compared the acute effects of a conventionally recommended (CR) diet and CRHP diet [55/30 energy percent (E%) carbohydrate and 15/30 E% protein, respectively] in RYGB patients. Methods Ten individuals (2 males, 8 females, mean ± SD age 47 ± 7 y; stable body mass index 31 ± 6 kg/m2; 6 ± 3 y post-RYGB) with recurrent postprandial hypoglycemia documented by plasma glucose (PG) ≤3.4 mmol/L were examined on 2 d with isoenergetic CRHP or CR diets comprising a breakfast and subsequent lunch meal. Results Peak PG was significantly reduced on the CRHP diet after breakfast and lunch by 11% and 31% compared with the CR diet. Nadir PG increased significantly on CRHP (by 13% and 9%). Insulin secretion was reduced, and glucagon secretion increased on the CRHP diet after both meals. Glucagon-like peptide 1 and glucose-dependent insulinotropic polypeptide secretion were lower after lunch but unaltered after breakfast on CRHP; β-cell function and insulin clearance were unchanged. Conclusions The CRHP diet lowered glucose excursions and reduced insulin secretion and incretin hormone responses, but enhanced glucagon responses compared with the CR diet. Taken together, the results may explain the decreased glucose variability and lower risk of postprandial hypoglycemia. This study was registered at clinicaltrials.gov as NCT02665715.

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