Evidence map›Paper›PMID 28855269›Full record

ArticleEuropean journal of endocrinology2017

Roles of increased glycaemic variability, GLP-1 and glucagon in hypoglycaemia after Roux-en-Y gastric bypass.

George Tharakan, Preeshila Behary, Nicolai J Wewer Albrechtsen, Harvinder Chahal, Julia Kenkre, Alexander D Miras, Ahmed R Ahmed, Jens J Holst, Stephen R Bloom, Tricia Tan

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In one paragraph

Article in European journal of endocrinology, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 42 papers, 5 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
42citing papers in PubMed, 5 pooled it
6.4field-weighted citation impact, top 3% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

42 citing papers in PubMed, 5 syntheses or guidelines pooled it, 60 citations in OpenAlex.

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  10. Type 2 Diabetes Mellitus Remission, Dream or Reality? A Narrative Review of Current Evidence and Integrated Care Strategies.Diabetes therapy : research, treatment and education of diabetes and related disorders · 2025
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4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

10 authors at 3 institutions in 2 countries.

George TharakanDivision of Diabetes, Endocrinology and Metabolism, Imperial College London, London, UK.
Preeshila BeharyDivision of Diabetes, Endocrinology and Metabolism, Imperial College London, London, UK.
Nicolai J Wewer AlbrechtsenNNF Center for Basic Metabolic Research and Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
Harvinder ChahalDivision of Diabetes, Endocrinology and Metabolism, Imperial College London, London, UK.
Julia KenkreDivision of Diabetes, Endocrinology and Metabolism, Imperial College London, London, UK.
Alexander D MirasDivision of Diabetes, Endocrinology and Metabolism, Imperial College London, London, UK.
Ahmed R AhmedDepartment of Surgery, Imperial College Healthcare NHS Trust, London, UK.
Jens J HolstNNF Center for Basic Metabolic Research and Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
Stephen R BloomDivision of Diabetes, Endocrinology and Metabolism, Imperial College London, London, UK.
Tricia TanDivision of Diabetes, Endocrinology and Metabolism, Imperial College London, London, UK.
Imperial College London · GBUniversity of Copenhagen · DKImperial College Healthcare NHS Trust · GB

Funding

Department of Health EME/13/121/07Medical Research Council G0502025Medical Research Council G0802390Medical Research Council G0902002Medical Research Council G1000474Medical Research Council MR/J010731/1Medical Research Council MR/K02115X/1Medical Research Council MR/L013088/1Wellcome Trust
6 · The paper itself

Abstract

objectiveRoux-en-Y gastric bypass (RYGB) surgery is currently the most effective treatment for diabetes and obesity. An increasingly recognized and highly disabling complication of RYGB is postprandial hypoglycaemia (PPH). The pathophysiology of PPH remains unclear with multiple mechanisms suggested including nesidioblastosis, altered insulin clearance and increased glucagon-like peptide-1 (GLP-1) secretion. Whilst many PPH patients respond to dietary modification, some have severely disabling symptoms. Multiple treatments are proposed, including dietary modification, GLP-1 antagonism, GLP-1 analogues and even surgical reversal, with none showing a more decided advantage over the others. A greater understanding of the pathophysiology of PPH could guide the development of new therapeutic strategies.

methodsWe studied a cohort of PPH patients at the Imperial Weight Center. We performed continuous glucose monitoring to characterize their altered glycaemic variability. We also performed a mixed meal test (MMT) and measured gut hormone concentrations.

resultsWe found increased glycaemic variability in our cohort of PPH patients, specifically a higher mean amplitude glucose excursion (MAGE) score of 4.9. We observed significantly greater and earlier increases in insulin, GLP-1 and glucagon in patients who had hypoglycaemia in response to an MMT (MMT Hypo) relative to those that did not (MMT Non-Hypo). No significant differences in oxyntomodulin, GIP or peptide YY secretion were seen between these two groups.

conclusionAn early peak in GLP-1 and glucagon may together trigger an exaggerated insulinotropic response to eating and consequent hypoglycaemia in patients with PPH.

Indexed as

Blood GlucoseCohort StudiesCombined Modality TherapyDiabetes Mellitus, Type 2Diet, DiabeticDiet, ReducingFemaleGastric BypassGlucagonGlucagon-Like Peptide 1HumansHypoglycemiaInsulinInsulin SecretionLondonMaleBlood GlucoseGlucagonGlucagon-Like Peptide 1Insulin

Identifiers

PMID28855269
PMCPMC5642268
OpenAlexW2751092137

What OpenQuestion holds

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Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.