Abstract
Purpose
The purposes of this study are to identify the cumulative incidence of post-bariatric surgery hypoglycemia (PBSH), describe its symptomatology, and characterize treatment patterns at a large academic institution.
Materials and Methods
All patients who underwent bariatric surgery at a single institution from 1985 to 2015 were identified using a clinical database, administrative billing data identified patients who were treated for hypoglycemia, and chart reviews were performed to make a diagnosis of PBSH based on Whipple’s triad. PBSH cases were reviewed including patient diabetes history, symptomatology, and treatment measures. Univariate analyses were performed to identify correlations based on symptomatology, laboratory values, and treatments utilized.
Results
Ninety (2.6%) of 3487 patients were diagnosed with PBSH with preoperative median age of 43 years, mean BMI of 50.0 kg/m2, and median glycated hemoglobin of 6.0%. Median time-to-first hypoglycemic event was 40.6 months. No factors were identified which predict symptom severity or resolution. The 24 (27%) patients who received pharmacotherapy to treat hypoglycemia were younger, had lower nadir blood glucose levels, and more frequent symptoms. Sixty-nine (79%) cases eventually resolved.
Conclusions
PBSH onset and severity are highly variable. Successful management of these patients can prove difficult and should include dietary therapy, the selective use of pharmacotherapy and surgery, and the use of a multidisciplinary team including bariatric surgeons and endocrinologists.
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Research reported in this publication was supported by the National Institutes of Health under award numbers T32AI0074 (ADM) and T32HL07849 (JHM).
Conflict of Interest
Dr. Michaels reports grants from the National Institutes of Health during the conduct of the study. Dr. Mehaffey reports grants from the National Institutes of Health during the conduct of the study. Dr. French, Dr. Schirmer, Dr. Kirby, and Dr. Hallowell declare that they have no conflict of interest.
Ethical Statement
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
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For this type of study, formal consent is not required.
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Michaels, A.D., Hunter Mehaffey, J., Brenton French, W. et al. Hypoglycemia Following Bariatric Surgery: Our 31-Year Experience. OBES SURG 27, 3118–3123 (2017). https://doi.org/10.1007/s11695-017-2734-2
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DOI: https://doi.org/10.1007/s11695-017-2734-2