Increased Risk of Hypoglycemia Following Roux-en-Y Gastric Bypass Surgery in Patients Without Diabetes: a Propensity Score-Matched Analysis.

IF 2.9 3区医学 Q1 SURGERY Obesity Surgery Pub Date : 2024-11-13 DOI:10.1007/s11695-024-07565-y

Eman A Toraih, Mohamed Doma, Aria Kaur Atwal, Benito Vlassis, Ahmed Abdelmaksoud, Hani Aiash, Runa Acharya

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Abstract

Background: Roux-en-Y gastric bypass (RYGB) surgery is an effective treatment for obesity. However, the incidence and long-term risk of hypoglycemia after surgery in patients without diabetes remains unclear. This study aimed to investigate the prevalence of hypoglycemia following RYGB surgery in patients with obesity and without diabetes.

Methods: A retrospective cohort study was conducted using the TriNetX database. The study population included 15,085 patients with obesity (BMI ≥ 30 kg/m²) who underwent RYGB surgery and 3,200,074 non-surgical controls, all without a history of diabetes or GLP-1 receptor agonist use. Propensity score matching was performed to balance baseline characteristics. The primary outcome was the incidence of hypoglycemia, defined by ICD-10-CM codes or laboratory values (glucose ≤ 70 mg/dL). Cox regression analysis was employed to calculate hazard ratios (HR) and 95% confidence intervals (CI).

Results: In the overall study population, the risk of hypoglycemia was significantly higher in the RYGB group (18.70%, n = 2,810) compared to the control group (3.80%, n = 120,923; HR 4.3, 95% CI 4.14-4.46, p < 0.001). After propensity score matching (n = 14,916 per group), RYGB patients maintained an elevated risk (18.70%, n = 2,795) compared to matched controls (5.0%, n = 749; HR 3.7, 95% CI 3.44-4.05, p < 0.001). Time-series analysis revealed consistently higher hypoglycemia risk in the RYGB group, with hazard ratios ranging from 5.37 (95% CI 4.09-7.03) at 1 week to 3.75 (95% CI 3.45-4.06) at 10 years post-surgery (all p < 0.001). Subgroup analysis of RYGB patients who developed hypoglycemia showed a 30-day hospitalization rate of 21.3% and a mortality rate of 0.71%.

Conclusion: RYGB surgery is associated with a significantly increased risk of hypoglycemia in patients with obesity and without diabetes, both in the short-term and long-term follow-up. These findings underscore the importance of monitoring and managing hypoglycemia in patients undergoing RYGB surgery, even in the absence of preexisting diabetes.

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无糖尿病患者接受 Roux-en-Y 胃旁路手术后发生低血糖的风险增加：倾向评分匹配分析。

背景：Roux-en-Y 胃旁路（RYGB）手术是治疗肥胖症的有效方法。然而，无糖尿病患者术后低血糖的发生率和长期风险仍不清楚。本研究旨在调查肥胖症患者和非糖尿病患者接受 RYGB 手术后低血糖症的发生率：方法：使用 TriNetX 数据库进行了一项回顾性队列研究。研究对象包括15,085名接受RYGB手术的肥胖症患者（体重指数≥30 kg/m2）和3,200,074名非手术对照组患者，他们均无糖尿病史或GLP-1受体激动剂使用史。为平衡基线特征，进行了倾向评分匹配。主要结果是低血糖发生率，以 ICD-10-CM 编码或实验室值（血糖≤ 70 mg/dL）定义。采用 Cox 回归分析法计算危险比 (HR) 和 95% 置信区间 (CI)：结果：在整个研究人群中，RYGB 组（18.70%，n = 2,810 人）发生低血糖的风险明显高于对照组（3.80%，n = 120,923 人；HR 4.3，95% CI 4.14-4.46，p 结论：RYGB 手术与低血糖相关：无论在短期还是长期随访中，RYGB 手术都会显著增加肥胖患者和非糖尿病患者发生低血糖的风险。这些发现强调了对接受 RYGB 手术的患者进行低血糖监测和管理的重要性，即使患者之前没有糖尿病。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Obesity Surgery 医学-外科

CiteScore

5.80

自引率

24.10%

发文量

567

审稿时长

3-6 weeks

期刊介绍： Obesity Surgery is the official journal of the International Federation for the Surgery of Obesity and metabolic disorders (IFSO). A journal for bariatric/metabolic surgeons, Obesity Surgery provides an international, interdisciplinary forum for communicating the latest research, surgical and laparoscopic techniques, for treatment of massive obesity and metabolic disorders. Topics covered include original research, clinical reports, current status, guidelines, historical notes, invited commentaries, letters to the editor, medicolegal issues, meeting abstracts, modern surgery/technical innovations, new concepts, reviews, scholarly presentations and opinions. Obesity Surgery benefits surgeons performing obesity/metabolic surgery, general surgeons and surgical residents, endoscopists, anesthetists, support staff, nurses, dietitians, psychiatrists, psychologists, plastic surgeons, internists including endocrinologists and diabetologists, nutritional scientists, and those dealing with eating disorders.