目的:减重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,管理仍然不理想,因为对潜在的病理生理学了解不足。尚未系统地检查有和没有减肥手术后低血糖的个体对营养素的葡萄糖调节激素反应。
方法:研究方案在PROSPERO前瞻性注册。PubMed,EMBASE,在1990年1月至2021年11月之间,使用与减肥手术后低血糖相关的MeSH术语搜索了WebofScience和Cochrane数据库的出版物。如果他们评估患有减肥手术后低血糖的个体,并包括血浆胰高血糖素样肽-1(GLP-1)的测量,葡萄糖依赖性促胰岛素多肽(GIP),胰岛素,摄入营养负荷后的C肽和/或胰高血糖素浓度。还评估了糖化血红蛋白(HbA1c)。进行了随机效应荟萃分析,在有足够研究的情况下,报告所有结局的Hedges\'g(标准化平均差)和95%置信区间。τ2估计值和I2统计量用作异质性的检验,并使用基于Egger回归检验的漏斗图评估发表偏倚。
结果:从377种确定的出版物中,分析中包括12个。在所有12项研究中,减肥手术的类型为Roux-en-Y胃旁路术(RYGB).比较摄入营养负荷后有和没有减肥手术后低血糖的个体,GLP-1峰值的标准化平均差为0.57(95%CI,0.32,0.82),峰值GIP0.05(-0.26,0.36),峰值胰岛素0.84(0.44,1.23),峰C肽0.69(0.28,1.1)和峰胰高血糖素0.05(-0.26,0.36)。HbA1c在低血糖患者中降低-0.40(-0.67,-0.12)。除了峰值胰岛素:τ2=0.2,I2=54.3外,没有任何结果的实质性异质性的证据。没有明显的发表偏倚。
结论:在RYGB之后,减肥手术后低血糖患者餐后血浆GLP-1、胰岛素和C肽峰值浓度更高,而HbA1c较少。这些观察结果支持以下概念:GLP-1的拮抗作用将证明有益于在RYGB后患有低血糖的个体的管理。PROSPERO注册号:CRD42021287515。
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.
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.
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.
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.