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Continuous glucose monitoring reveals glycemic variability and hypoglycemia after vertical sleeve gastrectomy in rats.

Citation
Evers, S. S., et al. “Continuous Glucose Monitoring Reveals Glycemic Variability And Hypoglycemia After Vertical Sleeve Gastrectomy In Rats.”. Molecular Metabolism, pp. 148-159.
Center University of Michigan
Author Simon S Evers, Ki-Suk Kim, Nadejda Bozadjieva, Alfor G Lewis, Diana Farris, Matthew J Sorensen, Youngsoo Kim, Steven E Whitesall, Robert T Kennedy, Daniel E Michele, Randy J Seeley, Darleen A Sandoval
Keywords Continuous glucose monitoring, Exendin 9-39, Glucagon-like peptide-1 receptor, Glycemic variability, Post–bariatric surgery hypoglycemia, vertical sleeve gastrectomy
Abstract

OBJECTIVE: Post-bariatric surgery hypoglycemia (PBH) is defined as the presence of neuroglycopenic symptoms accompanied by postprandial hypoglycemia in bariatric surgery patients. Recent clinical studies using continuous glucose monitoring (CGM) technology revealed that PBH is more frequently observed in vertical sleeve gastrectomy (VSG) patients than previously recognized. PBH cannot be alleviated by current medication. Therefore, a model system to investigate the mechanism and treatment is required.

METHODS: We used CGM in a rat model of VSG and monitored the occurrence of glycemic variability and hypoglycemia in various meal conditions for 4 weeks after surgery. Another cohort of VSG rats with CGM was used to investigate whether the blockade of glucagon-like peptide-1 receptor (GLP-1R) signaling alleviates these symptoms. A mouse VSG model was used to investigate whether the impaired glucose counterregulatory system causes postprandial hypoglycemia.

RESULTS: Like in humans, rats have increased glycemic variability and hypoglycemia after VSG. Postprandial hypoglycemia was specifically detected after liquid versus solid meals. Further, the blockade of GLP-1R signaling raises the glucose nadir but does not affect glycemic variability.

CONCLUSIONS: Rat bariatric surgery duplicates many features of human post-bariatric surgery hypoglycemia including postprandial hypoglycemia and glycemic variability, while blockade of GLP-1R signaling prevents hypoglycemia but not the variability.

Year of Publication
2020
Journal
Molecular metabolism
Volume
32
Number of Pages
148-159
Date Published
12/2020
ISSN Number
2212-8778
DOI
10.1016/j.molmet.2019.12.011
Alternate Journal
Mol Metab
PMID
32029224
PMCID
PMC7005148
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