511 - Prevalence and Clinical Associations of Reactive Hypoglycemia in Adolescent Girls with Obesity

Poster Number: 511
Publication Number: 511.238

Meredith A. Ware, Rocky Vista University School of Osteopathic Medicine, Aurora, CO, United States; Cecilia Diniz Behn, Colorado School of Mines, Golden, CO, United States; Yesenia Garcia Reyes, University of Colorado School of Medicine, Aurora, CO, United States; Haseeb Rahat, Children's Hospital Colorado, Aurora, CO, United States; Laura Pyle, University of Colorado Anschutz Medical Campus, Aurora, CO, United States; Kristen Nadeau, University of Colorado School of Medicine, Denver, CO, United States; Melanie Cree-Green, University of Colorado School of Medicine, Aurora, CO, United States

Background: Reactive hypoglycemia (RH) can present as episodes of excess sweating, nausea, and dizziness following consumption of high-sugar foods. These symptoms are commonly described in adolescent girls with little medical evaluation or treatment recommendations beyond hydration and stress management. Little is known about the prevalence or clinical associations of RH in adolescent girls with obesity.

Objective: To identify prevalence and clinical associations of RH in obese adolescent girls.

Design/Methods: Secondary analysis of females ages 12-21 yrs and BMI≥90th percentile who completed fasting labs and a 4-hr oral sucrose tolerance test (OSTT, 75 g glucose+25 g fructose). Data were stratified by glucose nadir after 120 min: ≤60 mg/dL as RH, 61-79 mg/dL as indeterminate (IND), ≥80 mg/dL as normoglycemia (NG). Group comparisons for demographic and lab values were performed using one-way ANOVA or Kruskal-Wallis test. Area under the curve (AUC) was calculated for glucose and insulin concentrations during the OSTT. Curves were compared with mixed-effects analysis.

Results: Data from 119 females were included: 12% percent had RH (n=14, age 16±2 yrs, BMI 37±6 kg/m2), 51% were IND (n=61, age 16±1, BMI 35±6) and 37% had NG (n=44, age 16±2, BMI 35±6). Physical characteristics including age, race/ethnicity, BMI, and BMI percentile were similar across groups. Average time of glucose nadir in RH was 219±22 min. OSTT glucose and insulin curves were significantly different across groups (p < 0.001). Post hoc analysis showed group differences in glucose concentrations at 180 min (NG >IND, p=0.002), 210 min (RH< NG, p< 0.001; NG >IND, p< 0.001), and 240 min (RH< NG, p< 0.001; RH< NG, p=0.05; NG > IND, p< 0.001). RH had higher insulin than NG at 240 min (p=0.015). AUC for glucose and insulin were similar across groups. Metabolic syndrome components including waist circumference, HbA1c, high-density lipoprotein, and triglycerides were similar across groups. Alanine aminotransferase (ALT) was significantly different between groups (p=0.019); post hoc revealed lower ALT in IND compared to RH (p=0.021) and NG (p=0.027).Conclusion(s): We observed that RH occurs in 12% of adolescent girls with obesity around 3.5 hrs after a liquid glucose load similar to that found in sodas, sports drinks, and energy drinks. No clinical features were associated with RH. In patients presenting with RH symptoms, timing of presentation in relation to food and drink should be queried to see if it is occurring 3-4 hours postprandial. If RH is suspected, low-calorie beverage choices can be advised for symptom management, in addition to obesity management.
CV for Meredith WareFull CV_19Nov2021.pdf