510033 Vortragsreihe Medizinische Forschung: "CGM als diagnostisches und therapeutisches Tool in der Nachsorge von bariatrischen Patient*innen" (1 UE) (V+Ko) (SoSe 2025)

abstract von Pape-Köhler

Background
Bariatric surgery, particularly Roux-en-Y gastric bypass (RYGB), has a well-established impact on glucose regulation, potentially altering insulin sensitivity and glucose metabolism. Continuous Glucose Monitoring (CGM) is increasingly used to monitor glucose variability and assess metabolic changes in various patient populations, including those post-bariatric surgery. However, its role in managing glucose control specifically for post-bariatric surgery patients remains underexplored. CGM could provide valuable insights into postprandial glucose fluctuations, which may help optimize care for these individuals.
Subject of the presentation will be to analyse the pathophysiological mechanisms underlying glucose regulation in bariatric patients, as well as to explore the potential of continuous glucose monitoring (CGM) to optimize glycemic control by a clinical case.
Objectives
A 45-year-old female patient, 14 years post-RYGB, with a histry of morbid obesity (BMI 52 kg/m2 at the time of surgery) and a current BMI of 29 kg/m2, presented with symptoms of postprandial fatigue, mild nausea, nocturnal cravings, morning fatigue, and unexplained weight gain. The patient had been following long-term care and adhering to nutritional guidelines without significant issues, but her symptoms persisted.
Methods
The patient was given a Continuous Glucose Monitoring (CGM) system (FreeStyle Libre 3) to track her glucose levels without changing her dietary or lifestyle habits.
Results
The initial CGM data revealed significant glucose fluctuations, including high peaks up to 220 mg/dL and hypoglycemic episodes as low as 45 mg/dL, with rapid swings in glucose levels. In response, the patient made dietary adjustments, reducing non-complex carbohydrates and increasing intake of vegetables, proteins, and complex carbs. These changes led to a noticeable improvement in her symptoms, reducing nocturnal hypoglycemia and improving overall well- being. Over two weeks, she experienced weight loss of 3 kg and an improvement in sleep and energy levels.
Conclusions
This case demonstrates the potential of CGM in managing glucose variability and empowering patients in the long-term follow-up after bariatric surgery. By using real-time glucose data, the patient was able to make informed dietary decisions. CGM allowed her to identify and to address problems e#ectively, improving quality of life and weight management. By this case observation mechanisms of glucose and insuline homeostasis after MBS can be betteer understood as well as the role of CGM as an easy to use and e#ecticve diagnostic and therapeutic option in MBS patients.

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