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Evaluation and Management of Patients Referred for Post-Bariatric Surgery Hypoglycemia at a Tertiary Care Center

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Abstract

Purpose

Following bariatric surgery, patients can develop non-specific symptoms self-described as hypoglycemia. However, confirming hypoglycemia can be technically challenging, and therefore, these individuals are frequently treated empirically. This study aimed to describe what diagnostic evaluation and therapeutic interventions patients referred for post-bariatric surgery hypoglycemia undergo.

Methods

Retrospective observational cohort study of patients with a history of bariatric surgery was evaluated for post-bariatric surgery hypoglycemia in a tertiary referral center from 2008 to 2017. We collected demographic and bariatric surgery information, clinical presentation of symptoms referred to as hypoglycemia, laboratory and imaging studies performed to evaluate these symptoms, and symptom management and outcomes.

Results

A total of 60/2450 (2.4%) patients who underwent bariatric surgery were evaluated in the Department of Endocrinology for hypoglycemia-related symptoms. The majority were middle-aged women without type 2 diabetes who had undergone Roux-en-Y gastric bypass. Thirty-nine patients (65%) completed a biochemical assessment for hypoglycemia episodes. Six (10%) had confirmed hypoglycemia by Whipple’s triad, and four (6.7%) met the criteria for post-bariatric surgery hypoglycemia based on clinical and biochemical criteria. All patients were recommended dietary modification as the initial line of treatment, and this intervention resulted in most patients reporting at least some improvement in their symptoms. Eight patients (13%) were prescribed pharmacotherapy, and two patients required additional interventions for symptom control.

Conclusions

In our experience, evaluation for hypoglycemia-related symptoms after bariatric surgery was rare. Hypoglycemia was confirmed in the minority of patients. Even without establishing a diagnosis of hypoglycemia, dietary changes were a helpful strategy for symptom management for most patients.

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Abbreviations

BMI:

Body mass index

PGBH:

Post-gastric bypass surgery hypoglycemia

RYGB:

Roux-en-Y gastric bypass

TBWL:

Total body weight loss

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Author information

Author notes

  1. Lizeth Cifuentes and Maria D. Hurtado contributed equally to this work.

Authors and Affiliations

  1. Precision Medicine for Obesity Program, Mayo Clinic, 200 1st SW, Rochester, MN, 55905, USA

    Lizeth Cifuentes, Maria D. Hurtado & Andres Acosta

  2. Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, 200 1st SW, Rochester, MN, 55905, USA

    Lizeth Cifuentes & Andres Acosta

  3. Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Department of Medicine, Mayo Clinic Health System, 700 West Av. South, La Crosse, WI, 64601, USA

    Maria D. Hurtado

  4. Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Department of Medicine, Mayo Clinic, 200 1st St SW, Rochester, MN, 55905, USA

    Maria D. Hurtado, Meera Shah & Maria L. Collazo-Clavell

  5. Division of Endocrinology, University of Texas Health, San Antonio, TX, 78229, USA

    Tiffany M. Cortes

  6. Division of Endocrinology, Diabetes, and Metabolism, University of New Mexico Health Sciences Center, Albuquerque, NM, 87106, USA

    Kristen Gonzales

Authors
  1. Lizeth Cifuentes
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Corresponding author

Correspondence to Maria L. Collazo-Clavell.

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Conflict of Interest

Andres Acosta is a stockholder in Gila Therapeutics, Phenomix Sciences; he served as a consultant for Rhythm Pharmaceuticals, General Mills. Lizeth Cifuentes, Maria D. Hurtado, Tiffany M. Cortes, Kristen Gonzales, Meera Shah, and Maria L. Collazo-Clavell declare that they have no conflicts of interest.

Statement of Human and Animal Rights

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. For this type of study formal informed consent is not required and does not apply.

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Key Points

• Post-bariatric surgery hypoglycemia is a rare post-surgical complication.

• Biochemical confirmation of post-bariatric surgery hypoglycemia is challenging in clinical practice.

• Dietary changes are a helpful strategy to manage symptoms in most patients; pharmacotherapy is reserved for cases that do not respond to dietary modification.

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Cifuentes, L., Hurtado, M.D., Cortes, T.M. et al. Evaluation and Management of Patients Referred for Post-Bariatric Surgery Hypoglycemia at a Tertiary Care Center. OBES SURG 32, 1578–1585 (2022). https://doi.org/10.1007/s11695-022-05986-1

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