J.Jpn. Surg. Soc.. 124(2): 172-176, 2023

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Feature topic

SIGNIFICANCE OF POST-GASTRECTOMY GLYCEMIC VARIABILITY

It is known that the post-gastrectomy blood glucose level fluctuates greatly as represented by late dumping syndrome, causing insulin-reactive hypoglycemia. We conducted a clinical study to clarify post-gastrectomy blood glucose trends using continuous glucose monitoring (CGM). At the same time as performing CGM for patients who underwent distal and total gastrectomy, dumping symptoms were investigated using Post-gastrectomy Syndrome Assessment Scale (PGSAS)-37 1 month and 1 year after surgery. As a result, blood glucose variability was large, especially after total gastrectomy, and the frequency of hypoglycemia increased, which did not improve even after 1 year. It was also revealed that some patients with hypoglycemia are unaware of it during the daytime and experience nocturnal hypoglycemia during sleep. There are many reports that glycemic variability and hypoglycemia are risk factors for cardiovascular complications and dementia. Therefore, controlling blood glucose variability after gastrectomy may contribute to improve prognosis. Post-gastrectomy patients have increased food intake over time and appear to have improved quality of life, but we should keep in mind that glycemic variability and hypoglycemia unawareness may be latent. Careful interviews and continuous nutritional therapy are required.

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