Evaluation of Postprandial Hypoglycemia in Patients with Nonalcoholic Fatty Liver Disease by Oral Glucose Tolerance Testing and Continuous Glucose Monitoring

Overview

Journal Eur J Gastroenterol Hepatol

Specialty Gastroenterology

Date 2018 Apr 11

PMID 29634665

Citations 1

Authors

Yusuke Oki

Masafumi Ono

Hideyuki Hyogo

Tsunehiro Ochi

Kensuke Munekage

Yasuko Nozaki

Akira Hirose

Kosei Masuda

Hiroshi Mizuta

Nobuto Okamoto

Toshiji Saibara

Affiliations

Soon will be listed here.

Abstract

Objective: Nonalcoholic fatty liver disease (NAFLD) is often associated with insulin resistance and glucose intolerance. Postprandial hypoglycemia frequently occurs in NAFLD patients; however, the details remain unclear.

Patients And Methods: The 75-g oral glucose tolerance test (75gOGTT) in 502 patients with biopsy-proven NAFLD and continuous glucose monitoring (CGM) in 20 patients were performed, and the characteristics and causes of postprandial hypoglycemia were investigated.

Results: The proportion of patients in the Hypo subgroup [plasma glucose (PG) at 180 min<fasting-PG (FPG)] among patients with normal glucose tolerance was significantly higher than that with diabetes mellitus and impaired glucose tolerance or impaired fasting glucose. FPG and hemoglobin A1c (HbA1c) were lower, and area under the curve of total insulin secretion within 120 min (<120 min) was higher in Hypo than Hyper in overall patients. Although FPG and PG at 30 min were higher in Hypo than Hyper, HOMA-IR and the insulinogenic index were not different in normal glucose tolerance and impaired glucose tolerance or impaired fasting glucose. In multivariate logistic regression analysis, low HbA1c, low fasting immunoreactive insulin, and high area under the curve of total insulin secretion (<120 min) were found to be independent factors associated with hypoglycemia. CGM showed postprandial hypoglycemia until lunch in 70% of NAFLD patients. However, no remarkable relationship in terms of hypoglycemia was identified between the 75gOGTT and CGM.

Conclusion: Postprandial hypoglycemia was identified in many NAFLD patients detected by 75gOGTT and CGM. It was clarified that important causes of postprandial hypoglycemia were related to low HbA1c, an early elevation of PG, low fasting and relatively low early insulin secretion, and delayed hyperinsulinemia.

Citing Articles

The Coexistence of Nonalcoholic Fatty Liver Disease and Type 2 Diabetes Mellitus.

Kosmalski M, Ziolkowska S, Czarny P, Szemraj J, Pietras T J Clin Med. 2022; 11(5).

PMID: 35268466 PMC: 8910939. DOI: 10.3390/jcm11051375.

References

Kimura Y, Hyogo H, Ishitobi T, Nabeshima Y, Arihiro K, Chayama K . Postprandial insulin secretion pattern is associated with histological severity in non-alcoholic fatty liver disease patients without prior known diabetes mellitus. J Gastroenterol Hepatol. 2010; 26(3):517-22. DOI: 10.1111/j.1440-1746.2010.06567.x. View

Klonoff D . Continuous glucose monitoring: roadmap for 21st century diabetes therapy. Diabetes Care. 2005; 28(5):1231-9. DOI: 10.2337/diacare.28.5.1231. View

Neuschwander-Tetri B, Clark J, Bass N, Van Natta M, Unalp-Arida A, Tonascia J . Clinical, laboratory and histological associations in adults with nonalcoholic fatty liver disease. Hepatology. 2010; 52(3):913-24. PMC: 3070295. DOI: 10.1002/hep.23784. View

Hashiba M, Ono M, Hyogo H, Ikeda Y, Masuda K, Yoshioka R . Glycemic variability is an independent predictive factor for development of hepatic fibrosis in nonalcoholic fatty liver disease. PLoS One. 2013; 8(11):e76161. PMC: 3819352. DOI: 10.1371/journal.pone.0076161. View

Tack J, Arts J, Caenepeel P, De Wulf D, Bisschops R . Pathophysiology, diagnosis and management of postoperative dumping syndrome. Nat Rev Gastroenterol Hepatol. 2009; 6(10):583-90. DOI: 10.1038/nrgastro.2009.148. View

Nannipieri M, Belligoli A, Guarino D, Busetto L, Moriconi D, Fabris R . Risk Factors for Spontaneously Self-Reported Postprandial Hypoglycemia After Bariatric Surgery. J Clin Endocrinol Metab. 2016; 101(10):3600-3607. DOI: 10.1210/jc.2016-1143. View

Chitturi S, Abeygunasekera S, Farrell G, Holmes-Walker J, Hui J, Fung C . NASH and insulin resistance: Insulin hypersecretion and specific association with the insulin resistance syndrome. Hepatology. 2002; 35(2):373-9. DOI: 10.1053/jhep.2002.30692. View

Papamargaritis D, Koukoulis G, Sioka E, Zachari E, Bargiota A, Zacharoulis D . Dumping symptoms and incidence of hypoglycaemia after provocation test at 6 and 12 months after laparoscopic sleeve gastrectomy. Obes Surg. 2012; 22(10):1600-6. DOI: 10.1007/s11695-012-0711-3. View

Morio R, Hyogo H, Hatooka M, Morio K, Kan H, Kobayashi T . The risk of transient postprandial oxyhypoglycemia in nonalcoholic fatty liver disease. J Gastroenterol. 2016; 52(2):253-262. DOI: 10.1007/s00535-016-1236-7. View

10.

Matteoni C, Younossi Z, Gramlich T, Boparai N, Liu Y, McCullough A . Nonalcoholic fatty liver disease: a spectrum of clinical and pathological severity. Gastroenterology. 1999; 116(6):1413-9. DOI: 10.1016/s0016-5085(99)70506-8. View

11.

Brunt E . Nonalcoholic steatohepatitis: definition and pathology. Semin Liver Dis. 2001; 21(1):3-16. DOI: 10.1055/s-2001-12925. View

12.

Hossain N, Afendy A, Stepanova M, Nader F, Srishord M, Rafiq N . Independent predictors of fibrosis in patients with nonalcoholic fatty liver disease. Clin Gastroenterol Hepatol. 2009; 7(11):1224-9, 1229.e1-2. DOI: 10.1016/j.cgh.2009.06.007. View

13.

Sonsuz A, Basaranoglu M, Bilir M, Senturk H, Akin P . Hyperinsulinemia in nondiabetic, both obese and nonobese patients with nonalcoholic steatohepatitis. Am J Gastroenterol. 2002; 97(2):495. DOI: 10.1111/j.1572-0241.2002.05510.x. View

14.

Whalan D . The ethics and morality of clinical trials in man. Med J Aust. 1975; 1(16):491-4. View

15.

Kanda Y . Investigation of the freely available easy-to-use software 'EZR' for medical statistics. Bone Marrow Transplant. 2012; 48(3):452-8. PMC: 3590441. DOI: 10.1038/bmt.2012.244. View

16.

Fracanzani A, Valenti L, Bugianesi E, Andreoletti M, Colli A, Vanni E . Risk of severe liver disease in nonalcoholic fatty liver disease with normal aminotransferase levels: a role for insulin resistance and diabetes. Hepatology. 2008; 48(3):792-8. DOI: 10.1002/hep.22429. View

17.

Ono M, Saibara T . Clinical features of nonalcoholic steatohepatitis in Japan: Evidence from the literature. J Gastroenterol. 2006; 41(8):725-32. DOI: 10.1007/s00535-006-1876-0. View

18.

Roslin M, Dudiy Y, Brownlee A, Weiskopf J, Shah P . Response to glucose tolerance testing and solid high carbohydrate challenge: comparison between Roux-en-Y gastric bypass, vertical sleeve gastrectomy, and duodenal switch. Surg Endosc. 2013; 28(1):91-9. DOI: 10.1007/s00464-013-3176-0. View

19.

Koschinsky T, Heinemann L . Sensors for glucose monitoring: technical and clinical aspects. Diabetes Metab Res Rev. 2001; 17(2):113-23. DOI: 10.1002/dmrr.188. View

20.

Manchanayake J, Chitturi S, Nolan C, Farrell G . Postprandial hyperinsulinemia is universal in non-diabetic patients with nonalcoholic fatty liver disease. J Gastroenterol Hepatol. 2010; 26(3):510-6. DOI: 10.1111/j.1440-1746.2010.06528.x. View