Postprandial plasma GLP-1 levels are elevated in individuals with postprandial hypoglycaemia following Roux-en-Y gastric bypass - a systematic review.

IF 6.9 2区 医学 Q1 ENDOCRINOLOGY & METABOLISM Reviews in Endocrine & Metabolic Disorders Pub Date : 2023-12-01 Epub Date: 2023-07-13 DOI:10.1007/s11154-023-09823-3
Ryan Joseph Jalleh, Mahesh Michael Umapathysivam, Mark Philip Plummer, Adam Deane, Karen Louise Jones, Michael Horowitz
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Abstract

Background and aims: Bariatric surgery is the most effective treatment in individuals with obesity to achieve remission of type 2 diabetes. Post-bariatric surgery hypoglycaemia occurs frequently, and management remains suboptimal, because of a poor understanding of the underlying pathophysiology. The glucoregulatory hormone responses to nutrients in individuals with and without post-bariatric surgery hypoglycaemia have not been systematically examined.

Materials and methods: The study protocol was prospectively registered with PROSPERO. PubMed, EMBASE, Web of Science and the Cochrane databases were searched for publications between January 1990 and November 2021 using MeSH terms related to post-bariatric surgery hypoglycaemia. Studies were included if they evaluated individuals with post-bariatric surgery hypoglycaemia and included measurements of plasma glucagon-like peptide-1 (GLP-1), glucose-dependent insulinotropic polypeptide (GIP), insulin, C-peptide and/or glucagon concentrations following an ingested nutrient load. Glycated haemoglobin (HbA1c) was also evaluated. A random-effects meta-analysis was performed, and Hedges' g (standardised mean difference) and 95% confidence intervals were reported for all outcomes where sufficient studies were available. The τ2 estimate and I2 statistic were used as tests for heterogeneity and a funnel plot with the Egger regression-based test was used to evaluate for publication bias.

Results: From 377 identified publications, 12 were included in the analysis. In all 12 studies, the type of bariatric surgery was Roux-en-Y gastric bypass (RYGB). Comparing individuals with and without post-bariatric surgery hypoglycaemia following an ingested nutrient load, the standardised mean difference in peak GLP-1 was 0.57 (95% CI, 0.32, 0.82), peak GIP 0.05 (-0.26, 0.36), peak insulin 0.84 (0.44, 1.23), peak C-peptide 0.69 (0.28, 1.1) and peak glucagon 0.05 (-0.26, 0.36). HbA1c was less in individuals with hypoglycaemia - 0.40 (-0.67, -0.12). There was no evidence of substantial heterogeneity in any outcome except for peak insulin: τ2 = 0.2, I2 = 54.3. No publication bias was evident.

Conclusion: Following RYGB, postprandial peak plasma GLP-1, insulin and C-peptide concentrations are greater in individuals with post-bariatric surgery hypoglycaemia, while HbA1c is less. These observations support the concept that antagonism of GLP-1 would prove beneficial in the management of individuals with hypoglycaemia following RYGB.PROSPERO Registration Number: CRD42021287515.

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一项系统综述:Roux-en-Y胃旁路治疗后餐后低血糖患者餐后血浆GLP-1水平升高。
背景和目的:减肥手术是肥胖患者缓解2型糖尿病最有效的治疗方法。减肥手术后低血糖经常发生,由于对潜在病理生理的了解不足,治疗仍然不够理想。在有或没有减肥手术后低血糖的个体中,血糖调节激素对营养的反应尚未被系统地研究过。材料和方法:研究方案在PROSPERO前瞻性注册。在PubMed、EMBASE、Web of Science和Cochrane数据库中检索1990年1月至2021年11月期间发表的与减肥手术后低血糖相关的MeSH术语。如果研究评估了减肥手术后低血糖患者,并测量了摄入营养负荷后血浆胰高血糖素样肽-1 (GLP-1)、葡萄糖依赖性胰岛素性多肽(GIP)、胰岛素、c肽和/或胰高血糖素浓度,则纳入研究。糖化血红蛋白(HbA1c)也被评估。进行了随机效应荟萃分析,在有足够研究的情况下,报告了所有结果的Hedges' g(标准化平均差)和95%置信区间。使用τ2估计和I2统计量作为异质性检验,并使用基于Egger回归检验的漏斗图来评估发表偏倚。结果:从377篇确定的出版物中,12篇被纳入分析。在所有12项研究中,减肥手术的类型都是Roux-en-Y胃旁路手术(RYGB)。在摄入营养负荷后,比较有和没有减肥手术后低血糖的个体,GLP-1峰的标准化平均差异为0.57 (95% CI, 0.32, 0.82), GIP峰0.05(-0.26,0.36),胰岛素峰0.84 (0.44,1.23),c肽峰0.69(0.28,1.1)和胰高血糖素峰0.05(-0.26,0.36)。低血糖患者的HbA1c较低,为0.40(-0.67,-0.12)。除胰岛素峰值τ2 = 0.2, I2 = 54.3外,其他结果均无显著异质性。没有明显的发表偏倚。结论:RYGB后,减肥手术后低血糖患者餐后血浆GLP-1、胰岛素和c肽浓度峰值较高,而HbA1c较低。这些观察结果支持了GLP-1拮抗剂将被证明对RYGB后低血糖患者的管理有益的概念。普洛斯彼罗注册号:CRD42021287515。
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来源期刊
Reviews in Endocrine & Metabolic Disorders
Reviews in Endocrine & Metabolic Disorders 医学-内分泌学与代谢
CiteScore
14.70
自引率
1.20%
发文量
75
审稿时长
>12 weeks
期刊介绍: Reviews in Endocrine and Metabolic Disorders is an international journal dedicated to the field of endocrinology and metabolism. It aims to provide the latest advancements in this rapidly advancing field to students, clinicians, and researchers. Unlike other journals, each quarterly issue of this review journal focuses on a specific topic and features ten to twelve articles written by world leaders in the field. These articles provide brief overviews of the latest developments, offering insights into both the basic aspects of the disease and its clinical implications. This format allows individuals in all areas of the field, including students, academic clinicians, and practicing clinicians, to understand the disease process and apply their knowledge to their specific areas of interest. The journal also includes selected readings and other essential references to encourage further in-depth exploration of specific topics.
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