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New Glucagon Delivery System Tested for Treating Hypoglycemia after Bariatric Surgery

bariatric surgery is on the rise. Numbers of bariatric surgeries per year increased by 37 percent between 2011 and 2016. People who get the surgeries see an average weight reduction of about 50 percent. And benefits extend beyond weight loss. Whether it’s gastric bypass, gastric band, or any of the other variations, bariatric surgery in general has proven to be a very effective treatment for type 2 diabetes. People who get the surgeries can look forward to decreased blood glucose levels, improved A1Cs, and better blood pressure.

But with all the good comes a little bad: there is an increase in hypoglycemic episodes in some people who have had bariatric surgery. A study from Joslin explored the use of an automatic glucagon delivery system to help manage this complication.

Glucagon is a hormone produced by the body that’s responsible for quickly raising blood sugar. A synthetic form of glucagon is given as an injection to people with diabetes during episodes of dangerously low blood glucose.

In the recent study, researchers tested a system that could sense and respond to a patient’s hypoglycemia. The system consisted of a continuous glucose monitor, a pump-ready form of glucagon, and a computer program that can predict when hypoglycemia is likely to strike. This system was developed together with Eyal Dassau PhD and Alejandro Laguna PhD, of the Harvard School of Engineering and Applied Sciences.

Participants in this study were closely observed in a clinical setting. They were given a high-carb liquid to induce hyperglycemia, which then triggers insulin release and induces subsequent hypoglycemia. This chain of events happens because of a combination of hormonal changes and alteration in transit of food through the intestine due to the surgery.

Dr. Mary-Elizabeth Patti and Dr. Christopher Mulla
When the program noticed an imminent episode of hypoglycemia, it beeped to alert the researchers that they needed to administer a dose of glucagon. Researchers fine-tuned the app and the glucagon doses throughout the study. By the end, the use of the system significantly reduced the amount of time study participants were hypoglycemic. A follow-up will close the loop and allow the system to monitor and administer on its own based on the data gathered from this initial work.

Mary-Elizabeth Patti, MD, FACP, Director of the Hypoglycemia Clinic at Joslin Diabetes Center, was the senior author of the paper reporting these findings. Lead author and Joslin endocrinologist Christopher Mulla, M.D., also noted that “while this system was specifically created for the unique glucose patterns in patients who have post-bariatric hypoglycemia, a similar system could be used for individuals with type 1 or type 2 diabetes who are affected by severe hypoglycemia, in order to prevent severe hypoglycemia.”

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