Hypoglycemia After Upper Gastrointestinal Surgery: Clinical Approach to Assessment, Diagnosis, and Treatment

Abstract

Context

Post-bariatric hypoglycemia (PBH) is an increasingly encountered complication of upper gastrointestinal surgery; the prevalence of this condition is anticipated to rise given yearly increases in bariatric surgical procedures. While PBH is incompletely understood, there is a growing body of research describing the associated factors, mechanisms, and treatment approaches for this condition.

Evidence Acquisition

Data are integrated and summarized from studies of individuals affected by PBH and hypoglycemia following upper gastrointestinal surgery obtained from PubMed searches (1990–2020).

Evidence Synthesis

Information addressing etiology, incidence/prevalence, clinical characteristics, assessment, and treatment were reviewed and synthesized for the practicing physician. Literature reports were supplemented by clinical experience as indicated, when published data were not available.

Conclusion

PBH can be life-altering and severe for a subset of individuals. Given the chronic nature of this condition, and sequelae of both acute and recurrent episodes, increasing provider awareness of both the condition and associated risk factors is critical for assessment, prompt diagnosis, treatment, and preoperative identification of individuals at risk.

Keywords:

• hypoglycemia
• post-bariatric hypoglycemia
• upper gastrointestinal surgery
• bariatric surgery

Acknowledgments

MEP gratefully acknowledges support from NIH R01 DK121995, R01 DK106193, U01 DK114156, and P30 DK036836 (DRC, Joslin Diabetes Center), and the Chan Zuckerberg Foundation.

Disclosure

MEP has been a coinvestigator on an NIH R44 grant together with Xeris Pharmaceuticals. MEP has consulted for Eiger Pharmaceuticals, has received investigator-initiated grant support from Janssen Pharmaceuticals, Dexcom, Medimmune, Sanofi, Astra-Zeneca, Jenesis, and Nuclea, has been a site investigator for XOMA and Xeris, acknowledges clinical trial research trial product support from Ethicon, Covidien, NovoNordisk, Nestle, and Dexcom within the past 5 years, and reports personal fees from Fractyl and grant support from Chan-Zuckerberg Initiative, and Helmsley Trust, during the conduct of the study. In addition, MEP has a patent hypoglycemia treatment issued for hypoglycemia markers and has submitted a patent application regarding plasma proteins contributing to hypoglycemia and pump therapies for hypoglycemia. The authors report no other potential conflicts of interest for this work.