Incidence of Hypoglycemia after Gastric Bypass vs Sleeve Gastrectomy: A Randomized Trial

Esmeralda Capristo, Simona Panunzi, Andrea De Gaetano, Valerio Spuntarelli, Rocco Bellantone, Piero Giustacchini, Andreas L. Birkenfeld, Stephanie Amiel, Stefan R. Bornstein, Marco Raffaelli, Geltrude Mingrone*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

79 Citations (Scopus)


Context We compared the incidence of hypoglycemia after Roux-en-Y gastric bypass (RYGB) vs sleeve gastrectomy (SG). Design, Setting, and Main Outcome Measures Randomized, open-label trial conducted at the outpatient obesity clinic in a university hospital in Rome, Italy. The primary aim was the incidence of reactive hypoglycemia (<3.1 mmol/L after 75-g oral glucose load) at 1 year after surgery. Secondary aims were hypoglycemia under everyday life conditions, insulin sensitivity, insulin secretion, and lipid profile. Results Of 175 eligible patients, 120 were randomized 1:1 to RYGB or SG; 117 (93%) completed the 12-month follow-up. Reactive hypoglycemia was detected in 14% and 29% of SG and RYGB patients (P = 0.079), respectively, with the effect of treatment in multivariate analysis significant at P = 0.018. Daily hypoglycemic episodes during continuous glucose monitoring did not differ between groups (P = 0.75). Four of 59 RYGB subjects (6.8%) had 1 to 3 hospitalizations for symptomatic hypoglycemia vs 0 in SG. The static β-cell glucose sensitivity index increased after both treatments (P < 0.001), but the dynamic β-cell glucose sensitivity index increased significantly in SG (P = 0.008) and decreased in RYGB (P = 0.004 for time × treatment interaction). Whole-body insulin sensitivity increased about 10-fold in both groups. Conclusions We show that reactive hypoglycemia is no less common after SG and is not a safer option than RYGB, but RYGB is associated with more severe hypoglycemic episodes. This is likely due to the lack of improvement of β-cell sensitivity to changes in circulating glucose after RYGB, which determines an inappropriately high insulin secretion.

Original languageEnglish
Pages (from-to)2136-2146
Number of pages11
JournalJournal of Clinical Endocrinology and Metabolism
Issue number6
Publication statusPublished - 1 Jun 2018


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