Role of the entero-insular axis in the pathogenesis of idiopathic reactive hypoglycemia: A pilot study

Abstract

Context: Idiopathic reactive hypoglycemia (IRH) is characterized by recurrent episodes of symptomatic hypoglycemia occurring within 4 hours after meals. The underlying mechanisms remain obscure. Objective: This study aimed to investigate the response of the glucoregulatory and gastrointestinal hormones to an oral glucose load (OGTT) in individuals with documented IRH. Design and Setting: This was a cross-sectional study composed of outpatients referred to "Federico II" University of Naples. Patients:Weenrolled subjects with IRHdocumentedby a mixed meal under ordinary life conditions and healthy subjects as controls. Main Outcome Measure: We measured plasma glucose, insulin, glucagon-like peptide 1 (GLP-1), GIP, and glucagon response to a 75-g OGTT in cases and controls. Results: Ten IRH and eight control subjects were enrolled. During the OGTT, mean plasma glucose tended to be lower in IRH than in control subjects, reaching a statistically significant difference at 240 minutes (T240) (43 ±1.6 vs 72 ± 0.3 mg/dL; P = .001). Accordingly, the insulin response was higher in IRH than in control subjects (P