Introduction: Roux-en-Y gastric bypass (RYGB) is the most common surgical procedure for morbid obesity. However, it can present serious late complications, like postprandial hyperinsulinemic hypoglycemia (PHH). Recent data suggested an increase in intestinal SGLT-1 after RYGB. However, there is no data on the inhibition of SGLT-1 to prevent PHH in patients with prior RYBG. On this basis, we aimed to evaluate (a) the effect of canagliflozin 300 mg on the response to 100 g glucose overload (oral glucose tolerance test [OGTT]); (b) the pancreatic response after intra-arterial calcium stimulation in the context of PHH after RYGB. Materials and Methods: This is a prospective pilot study including patients (n = 21) with PHH after RYGB, matched by age and gender with healthy controls (n = 5). Basal OGTT and after 2 weeks of daily 300 mg of canagliflozin was performed in all cases. In addition, venous sampling after intra-arterial calcium stimulation of the pancreas was performed in 10 cases. Results: OGTT after canagliflozin showed a significant reduction of plasma glucose levels (minute 30: 161.5 ± 36.22 vs. 215.9 ± 58.11 mg/dL; minute 60: 187.46 ± 65.88 vs. 225.9 ± 85.60 mg/dL, p #x3c; 0.01) and insulinemia (minute 30: 95.6 ± 27.31 vs. 216.35 ± 94.86 mg/dL, p = 0.03; minute 60: 120.85 ± 94.86 vs. 342.64 ± 113.32 mIU/L, p #x3c; 0.001). At minute 180, a significant reduction (85.7%) of the rate of hypoglycemia was observed after treatment with canagliflozin (p #x3c; 0.00001). All cases presented normal pancreatic response after intra-arterial calcium administration. Conclusion: Canagliflozin (300 mg) significantly decreased glucose absorption and prevented PHH after 100 g OGTT in patients with RYGB. Our results suggest that canagliflozin could be a new therapeutic option for patients that present PHH after RYGB.
Obes Facts

中文翻译：

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Canagliflozin：Roux-en-Y 胃绕道术后出现餐后高胰岛素性低血糖患者的新治疗选择：一项初步研究

简介： Roux-en-Y 胃绕道术 (RYGB) 是最常见的病态肥胖手术。然而，它可能会出现严重的晚期并发症，如餐后高胰岛素低血糖症 (PHH)。最近的数据表明 RYGB 后肠道 SGLT-1 增加。然而，没有关于抑制 SGLT-1 以预防既往 RYBG 患者 PHH 的数据。在此基础上，我们旨在评估 (a) 卡格列净 300 mg 对 100 g 葡萄糖超负荷反应的影响（口服葡萄糖耐量试验 [OGTT]）；（ b ）在 RYGB 后 PHH 背景下动脉内钙刺激后的胰腺反应。材料和方法：这是一项前瞻性试验研究，包括患者（ n= 21) 与 RYGB 后的 PHH，按年龄和性别与健康对照 ( n = 5)匹配。在所有病例中进行基础 OGTT 和 2 周后每天 300 毫克卡格列净。此外，在10例胰腺动脉内钙刺激后进行静脉取样。结果： OGTT卡格列净后表现出减少显著血浆葡萄糖水平的（30分钟：161.5±36.22对比215.9±58.11毫克/分升; 60分钟：187.46±65.88对比225.9±85.60毫克/分升，p＃X3C; 0.01）和胰岛素血症（第 30 分钟：95.6 ± 27.31 与 216.35 ± 94.86 mg/dL，p = 0.03；第 60 分钟：120.85 ± 94.86 与 342.64 ± 113.32 mIU/L，p#x3c; 0.001）。在第 180 分钟，用卡格列净治疗后观察到低血糖发生率显着降低 (85.7%) ( p #x3c; 0.00001)。所有病例在动脉内钙给药后均表现出正常的胰腺反应。结论：卡格列净（300 mg）显着降低了 RYGB 患者的葡萄糖吸收并预防了 100 g OGTT 后的 PHH。我们的结果表明，对于 RYGB 后出现 PHH 的患者，卡格列净可能是一种新的治疗选择。
肥胖事实