Persistent post-bariatric-surgery hypoglycemia: A long-term follow-up reassessment

Background and aim: Post-bariatric-surgery hypoglycemia (PBH) is a serious compli-cation of bariatric surgery (BS). In our previous study about three quarters of the patients devel-oped PBH. However long-term follow-up data is lacking to determine whether this condition improves with time. The aim of the current study was to re-assess post-BS patients who partic-ipated in our previous study and determine whether there are changes in the frequency and/or severity of hypoglycemic events. Methods and results: Twenty-four post-BS, post Roux-en-Y gastric-bypass (RYGB = 10), post omega-loop gastric-bypass (OLGB = 9) and post sleeve-gastrectomy (SG = 5) individuals were reevaluated in a follow-up study 34.4 & PLUSMN; 4 months after their previous assessment and 67 & PLUSMN; 17 months since surgery. The evaluation included: a dietitian assessment, a questionnaire, meal-tolerance test (MTT) and a one-week masked continuous glucose monitoring (CGM). Hypoglyce-mia and severe hypoglycemia were defined by glucose levels & LE;54 mg/dl and & LE;40 mg/dl, respec-tively. Thirteen patients reported questionnaire meal-related complaints, mainly non-specific. During MTT, hypoglycemia occurred in 75% of the patients, and severe hypoglycemia in a third, but none was associated with specific complaints. During CGM, 66% of patients developed hypoglycemia and 37% had severe hypoglycemia. We did not observe significant improvements in hypoglyce-mic events compared to the previous assessment. Despite the high frequency of hypoglycemia, it did not necessitate hospitalizations or lead to death. Conclusions: PBH did not resolve within long-term follow-up. Intriguingly, most patient were un-aware of these events which can lead to underestimation by the medical staff. Further studies are needed to determine possible long term sequela of repeated hypoglycemia. & COPY; 2023 The Author(s). Published by Elsevier B.V. on behalf of The Italian Diabetes Society, the Italian Society for the Study of Atherosclerosis, the Italian Society of Human Nutrition and the Department of Clinical Medicine and Surgery, Federico II University. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).