Hypoglycemia following metabolic and bariatric surgery: evidence from objective and subjective naturalistic assessment methods.

Abstract

Background: Hypoglycemia (i.e., low blood glucose) is a potential complication following metabolic and bariatric surgery (MBS) that can ultimately result in severe and deadly consequences. However, the symptoms typically associated with hypoglycemia (e.g., dizziness, anxiety) can be nonspecific, which impairs effective monitoring.

Objectives: This study utilized a unique combination of naturalistic assessments to compare the subjective self-report of hypoglycemic symptoms measured via ecological momentary assessment (EMA) with objectively-collected data from continuous glucose monitoring (CGM).

Setting: Private Hospital, United States.

Methods: Participants were 44 adults who completed 10 days of EMA and CGM 1 year after undergoing Roux-en-Y gastric bypass. Multiple times per day during the EMA protocol, participants identified how many of 18 hypoglycemic symptoms they had experienced since they were last signaled several hours earlier.

Results: CGM data showed that ∼66% of participants experienced at least one possible daytime hypoglycemic event (range = 1-23 episodes/person). The total number of hypoglycemic symptoms endorsed via EMA did not correspond with the occurrence of a possible hypoglycemic event captured by CGM (P = .145). However, multilevel models revealed that participants were more likely to report feeling "shaky", "lightheaded", and "coordination problems/clumsiness" (false discovery rate corrected P values < .05) during periods of time coinciding with possible hypoglycemic events identified by CGM.

Conclusions: Many patients are at risk for low blood glucose post-MBS. In the absence of objective assessment, several subjective symptoms may serve as indicators of possible hypoglycemic events following MBS.