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Continuous Glucose Monitoring Captures Glycemic Variability After Roux-en-Y Gastric Bypass in Patients with and Without Type 2 Diabetes Mellitus: A Prospective Cohort Study

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Abstract

Purpose

To evaluate glycemic variability (GV) using continuous glucose monitoring (CGM) in individuals with and without type 2 diabetes mellitus (T2DM) undergoing Roux-en-Y gastric bypass (RYGB).

Methods

This prospective cohort study compared the CGM data of fourteen patients with T2DM (n = 7) and without T2DM (n = 7) undergoing RYGB. After 6 months, these patients were compared to a non-operative control group (n = 7) matched by BMI, sex, and age to the T2DM group.

Results

Fourteen patients underwent RYGB, with a mean BMI of 46.9 ± 5.3 kg/m2 and an average age of 47.9 ± 8.9 years; 85% were female. After 6 months post-surgery, the total weight loss (TWL) was 27.1 ± 6.3%, with no significant differences between the groups. Patients without diabetes had lower mean interstitial glucose levels (81 vs. 94 and 98 mg/dl, p < 0.01) and lower glucose management indicator (GMI) (5.2 vs. 5.6 and 5.65%, p = 0.01) compared to the control and T2DM groups, respectively. The coefficient of variation (CV) significantly increased only in patients with diabetes (17% vs. 26.7%, p < 0.01). Both groups with (0% vs. 2%, p = 0.03) and without (3% vs. 22%, p = 0.03) T2DM experienced an increased time below range with low glucose (54–69 mg/dL). However, patients without T2DM had significantly less time in rage (70–180 mg/dL) (97% vs. 78%, p = 0.04).

Conclusion

Significant differences in CGM metrics among RYGB patients suggest an increase in glycemic variability after surgery, with a longer duration of hypoglycemia, especially in patients without T2DM.

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Data Availability

The data that support the findings of this study are available at the request of the corresponding author. The data are not publicly available due to medical confidentiality and to not compromise the privacy of research participants.

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Acknowledgements

The authors sincerely thank Abbott Diabetes Care Inc. (CA, USA) for supporting the intermittently scanned continuous glucose monitor and all the participants in the study.

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Authors and Affiliations

  1. Unidade de Obesidade, Disciplina de Endocrinologia E Metabologia, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), R. Dr. Ovídio Pires de Campos, 225 - Cerqueira César, São Paulo, SP, 05403-010, Brazil

    Raquel do A. P. Quevedo, Maria Edna de Melo, Cintia Cercato, Ariana E. Fernandes & Marcio C. Mancini

  2. Unidade de Cirurgia Bariátrica E Metabólica, Disciplina de Cirurgia Do Aparelho Digestivo E Coloproctologia, Departamento de Gastroenterologia, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), R. Dr. Ovídio Pires de Campos, 225 - Cerqueira César, São Paulo, SP, 05403-010, Brazil

    Anna Carolina B. Dantas, Marco Aurélio Santo & Denis Pajecki

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  1. Raquel do A. P. Quevedo
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Corresponding author

Correspondence to Raquel do A. P. Quevedo.

Ethics declarations

Ethics Approval

All procedures performed in studies involving human participants were approved by the ethical standards of the institutional and/or national research committee and in accordance with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The research project has a Certificate of Presentation of Ethical Appreciation issued by the Research Ethics Committee of the HCFMUSP under number 17127119.0.0000.0068.

Consent to Participate

Informed consent was obtained from all individual participants included in the study. 

Conflict of Interest

Raquel do Amaral Prado Quevedo declares no conflict of interest. Maria Edna de Melo has received consulting fees and support for travel from Novo Nordisk and BracePharma. Cintia Cercato has served as an advisory board for Novo Nordisk and reports having received research grants from Eli-Lilly, Novo Nordisk, Merck, Boehringer Ingelheim, Eurofarma, Fractyl, BracePharma, and EMS. Ariana Ester Fernandes declares no conflict of interest. Anna Carolina Batista Dantas declares no conflict of interest. Marco Aurélio Santo declares no conflict of interest. Denis Pajecki declares no conflict of interest. Marcio C. Mancini has received consulting fees, honoraria, and support for meetings or travel from Merck, Lilly, Novo Nordisk, Takeda, EMS, Eurofarma, BracePharma, Science Valley, and Aché.

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Key Points

• We aimed to assess glycemic variability with CGM in individuals undergoing RYGB.

• Three groups were evaluated: RYGB with or without T2DM and a control group.

• Distinctive CV in the operated patients 6 months after RYGB.

CGM reveals an increase in glycemic variability after RYGB.

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Quevedo, R.d.A.P., de Melo, M.E., Cercato, C. et al. Continuous Glucose Monitoring Captures Glycemic Variability After Roux-en-Y Gastric Bypass in Patients with and Without Type 2 Diabetes Mellitus: A Prospective Cohort Study. OBES SURG (2024). https://doi.org/10.1007/s11695-024-07358-3

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  • DOI: https://doi.org/10.1007/s11695-024-07358-3

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