Presenter Disclosure Information. Christine Stier, Nina Malo,. Michael Frenken and Rudolf Weiner. Disclosed no conflict of interest ...
Presenter Disclosure Information Christine Stier, Nina Malo, Michael Frenken and Rudolf Weiner Disclosed no conflict of interest
Unreported Therapeutic Effect of Liraglutide in Late Dumping Syndrome Christine Stier, Nina Malo, Michael Frenken, Rudolf Weiner Department of Metabolic Surgery, Sana Klinik Offenbach, Germany
Introduction
Figure 1: without Liraglutide treatment
Dumping syndrome is a well-known complication after bariatric surgery that appears in about 3-5% of the cases, mostly after gastric bypass surgery. Its onset does not appear directly after surgery but 10 to 12 months after a mostly remarkable weight loss. The treatment is difficult and embraces dietary and medical intervention that solves this severe problem in about 60%. The other 40% remain a difficult problem to cure that may even indicate a reconstruction of the physiological GI-tract. In such an impasse we tried an off label use of Liraglutide with most success in 6 cases.
Methods
700
600
500
400 Insulin µU/ml
300
Glucose mg/dl 200
100
0
0 min
30 min
60 min
90 min
120 min
150 min
180 min
Insulin µU/ml
20,34
235,32
412,18
557,28
157,67
55,58
48,79
Glucose mg/dl
86
220
180
106
59
41
58
Figure 2: with 0,6 mg Liraglutide treatment
Mean age of the patients was 46 ± 11,26 y. All patients underwent an OGTT (oral Glucose testing) with synchronic insulin value assessment as basic measurement at baseline without any treatment. Treatment began with 0.6 mg Liraglutide per day for one week. After that dosage was increased to 1.2 mg. All steps of dosage were evaluated with OGTT and CGM (continuous glucose measurement).
700
600
500
400
Glucose mg/dl 200
100
0
Results
Insulin µU/ Glucose mg/dl
With 0,6 mg Liraglutide there was already a remarkable improvement of symptoms, but not a complete cure. With 1,2 mg of Liraglutide late dumping syndrome vanished in almost all patients (5/6) or was at least a considerable improve.
Insulin µU/
300
0 min
30 min
60 min
90 min
120 min
150 min
180 min
19,20
134,08
346,75
252,83
136,73
44,03
24,03
84
217
178
121
74
50
54
Figure 3: with 1,2 mg Liraglutide treatment 700
600
500
CGM pre- and post treatment
400 Insulin µU/ml
300
Glucose mg/ml 200
100
0
0 min
30 min
60 min
90 min
120 min
150 min
180 min
Insulin µU/ml
9,68
149,93
335,06
69,24
35,74
15,20
7,53
Glucose mg/ml
87
185
169
97
83
78
75
Conclusion This illustrates an unexpected effect of Liraglutide in managing hyperinsulinemic hypoglycemia indicating as late dumping syndrome. In absence of Liraglutide treatment, OGTT showed an early peaking of plasma glucose levels accompanied by tardy, disharmonic peaking of insulin and therefore resulting symptoms of dumping. Thus, dumping symptoms may be attributed to the delayed peaking of insulin while glucose level was already in decrease. With daily injections of 0.6 mg of Liraglutide, the peak level of insulin secretion was lowered and better in time than without Liraglutide. There was still a persistence of insulin level and a delayed decrease which still often led to delayed dumping symptoms due to ambiguity coordination of insulin and glucose level. Liraglutide treatment at a dose of 1.2 mg daily resulted in a better synchronized and adequate, decreased insulin level with correspondent extinction of late dumping symptoms.
