Unrecognized nocturnal hypoglycemia and glucose variability after gastrectomy: A prospective exploratory pilot study using continuous glucose monitoring with nutritional intervention.

INTRODUCTION

Dumping syndrome frequently complicates gastrectomy and is characterized by rapid postprandial glucose excursions and nocturnal hypoglycemia. Although asymptomatic hypoglycemia may persist after surgery, nocturnal hypoglycemia has been associated with cardiovascular risk and sudden death in patients with diabetes. Effective management strategies for post-gastrectomy patients remain limited. This study evaluated whether a diabetes-specific nutritional supplement designed to attenuate hyperglycemia could reduce glycemic variability and nocturnal hypoglycemia in patients with post-gastrectomy dumping syndrome.

METHODS

This prospective, single-center, single-arm exploratory pilot study enrolled 20 patients with post-gastrectomy dumping syndrome. Participants underwent a one-week control period followed by a one-week intervention period consuming Glucerna-REX® (200 mL) one hour before lunch and at bedtime. Continuous glucose monitoring (CGM) assessed glycemic profiles. Primary endpoints were the percentage of time that interstitial glucose levels were within time in range (TIR; 70-180 mg/dL) and time below range (TBR; <70 mg/dL). Symptoms were evaluated using the Esophagus and Stomach Surgery Symptom Scale (ES4).

RESULTS

Of 107 screened patients, 76 (71%) had dumping syndrome, and 19 completed the study. Following the intervention, TIR significantly increased from 84.3% to 88.9% (P = 0.015), while TBR decreased from 8.9% to 5.2% (P = 0.042). ES4 symptom scores associated with abdominal symptoms significantly worsened during the intervention period.

CONCLUSION

Regular intake of a low-carbohydrate, high-fat nutritional supplement was associated with improved CGM-derived glycemic indices, including increased time in range and reduced time below range in patients with dumping syndrome after gastrectomy. This simple, non-pharmacological intervention may represent a practical option for managing nocturnal hypoglycemia in post-gastrectomy patients.