Postbariatric surgery hypoglycemia: Nutritional, pharmacological and surgical perspectives.
bariatric surgery
complications
dumping syndrome
gastrectomy
obesity
post-bariatric hypoglycemia
Journal
Diabetes/metabolism research and reviews
ISSN: 1520-7560
Titre abrégé: Diabetes Metab Res Rev
Pays: England
ID NLM: 100883450
Informations de publication
Date de publication:
28 Nov 2023
28 Nov 2023
Historique:
revised:
09
10
2023
received:
03
05
2023
accepted:
03
11
2023
medline:
29
11
2023
pubmed:
29
11
2023
entrez:
29
11
2023
Statut:
aheadofprint
Résumé
Post-bariatric hypoglycaemia (PBH) is a metabolic complication of bariatric surgery (BS), consisting of low post-prandial glucose levels in patients having undergone bariatric procedures. While BS is currently the most effective and relatively safe treatment for obesity and its complications, the development of PBH can significantly impact patients' quality of life and mental health. The diagnosis of PBH is still challenging, considering the lack of definitive and reliable diagnostic tools, and the fact that this condition is frequently asymptomatic. However, PBH's prevalence is alarming, involving up to 88% of the post-bariatric population, depending on the diagnostic tool, and this may be underestimated. Given the prevalence of obesity soaring, and an increasing number of bariatric procedures being performed, it is crucial that physicians are skilled to diagnose PBH and promptly treat patients suffering from it. While the milestone of managing this condition is nutritional therapy, growing evidence suggests that old and new pharmacological approaches may be adopted as adjunct therapies for managing this complex condition.
Types de publication
Journal Article
Review
Langues
eng
Sous-ensembles de citation
IM
Pagination
e3750Informations de copyright
© 2023 The Authors. Diabetes/Metabolism Research and Reviews published by John Wiley & Sons Ltd.
Références
Lazar LO, Sapojnikov S, Pines G, et al: Symptomatic and asymptomatic hypoglycemia post three different bariatric procedures: a common and severe complication. Endocr Pract. 2019. https://doi.org/10.4158/ep-2019-0185
Kefurt R, Langer FB, Schindler K, Shakeri-Leidenmuhler S, Ludvik B, Prager G: Hypoglycemia after Roux-En-Y gastric bypass: detection rates of continuous glucose monitoring (CGM) versus mixed meal test. Surg Obes Relat Dis. 2015;11(3):564-569. https://doi.org/10.1016/j.soard.2014.11.003
Emous M, Wolffenbuttel BHR, Totte E, van Beek AP: The short- to mid-term symptom prevalence of dumping syndrome after primary gastric-bypass surgery and its impact on health-related quality of life. Surg Obes Relat Dis. 2017;13(9):1489-1500. https://doi.org/10.1016/j.soard.2017.04.028
Mechanick JI, Apovian C, Brethauer S, et al. Clinical practice guidelines for the perioperative nutrition, metabolic, and nonsurgical support of patients undergoing bariatric procedures - 2019 update: cosponsored by American association of clinical endocrinologists/American college of Endocrinology, the obesity society, American society for metabolic and bariatric surgery, obesity medicine association, and American society of anesthesiologists. Obesity. 2020;28(4):O1-O58. https://doi.org/10.1002/oby.22719
World Health Organization. Health Topics. Obesity. https://www.who.int/news-room/fact-sheets/detail/obesity-and-overweight
Watanabe M, Risi R, De Giorgi F, et al: Obesity treatment within the Italian national healthcare system tertiary care centers: what can we learn? Eat Weight Disord. 2021;26(3):771-778. https://doi.org/10.1007/s40519-020-00936-1
Eisenberg D, Azagury DE, Ghiassi S, Grover BT, Kim JJ: ASMBS position statement on postprandial hyperinsulinemic hypoglycemia after bariatric surgery. Surg Obes Relat Dis. 2017;13(3):371-378. https://doi.org/10.1016/j.soard.2016.12.005
Cryer PE, Axelrod L, Grossman AB, et al: Evaluation and management of adult hypoglycemic disorders: an endocrine society clinical practice guideline. J Clin Endocrinol Metab. 2009;94(3):709-728. https://doi.org/10.1210/jc.2008-1410
Cryer PE: The prevention and correction of hypoglycemia. Am J Physiol. 1993;264(2):E149-E155. https://doi.org/10.1152/ajpendo.1993.264.2.E149
Amiel SA, Sherwin RS, Simonson DC, Tamborlane WV Effect of intensive insulin therapy on glycemic thresholds for counterregulatory hormone. Diabetes. 1988;37(7):901-907. https://doi.org/10.2337/diab.37.7.901
Agiostratidou G, Anhalt H, Ball D, et al. Standardizing clinically meaningful outcome measures beyond HbA1c for type 1 diabetes: a consensus report of the American association of clinical endocrinologists, the American association of diabetes educators, the American diabetes association, the endocrine society, JDRF international, the Leona M. and Harry B. Helmsley charitable trust, the pediatric endocrine society, and the T1D exchange. Diabetes Care. 2017;40(12):1622-1630. https://doi.org/10.2337/dc17-1624
Towler DA, Havlin CE, Craft S, Cryer P Mechanism of awareness of hypoglycemia. Perception of neurogenic (predominantly cholinergic) rather than neuroglycopenic symptoms. Diabetes. 1993;42(12):1791-1798. https://doi.org/10.2337/diab.42.12.1791
Scarpellini E, Arts J, Karamanolis G, et al International consensus on the diagnosis and management of dumping syndrome. Nat Rev Endocrinol. 2020;16(8):448-466. https://doi.org/10.1038/s41574-020-0357-5
Hofeldt FD, Dippe S, Forsham PH Diagnosis and classification of reactive hypoglycemia based on hormonal changes in response to oral and intravenous glucose administration. Am J Clin Nutr. 1972;25(11):1193-1201. https://doi.org/10.1093/ajcn/25.11.1193
Hemmingsson JU, Leijonmarck CE, Klingvall M Postbariatric hypoglycemia in symptomatic versus asymptomatic patients: proposals for clinical assessments. BMJ Open Diab Res Ca. 2022;10(5):e002572. https://doi.org/10.1136/bmjdrc-2021-002572
Lee CJ, Clark JM, Schweitzer M, et al Prevalence of and risk factors for hypoglycemic symptoms after gastric bypass and sleeve gastrectomy. Obesity. 2015;23(5):1079-1084. https://doi.org/10.1002/oby.21042
Permutt MA Postprandiol hypoglycemia. Diabetes. 1976;25(8):719-733. https://doi.org/10.2337/diab.25.8.719
Lev-Ran A, Anderson RW The diagnosis of postprandial hypoglycemia. Diabetes. 1981;30(12):996-999. https://doi.org/10.2337/diab.30.12.996
Hogan MJ, Service FJ, Sharbrough FW, Gerich JE Oral glucose tolerance test compared with a mixed meal in diagnosis of reactive hypoglycemia a caveat on stimulation. Mayo Clin Proc. 1983;58:491-496.
Arthur Charles M, Hofeldt F, Shackelford A, et al Comparison of oral glucose tolerance test and mixed meals in patients with apparent idiopathic postabsorptive hypoglycemia: absence of hypoglycemia after meals. Diabetes. 1981;30(6):465-470. https://doi.org/10.2337/diabetes.30.6.465
Salehi M Postprandial hypoglycemia after gastric bypass surgery: from pathogenesis to diagnosis and treatment. Curr Opin Clin Nutr Metab Care. 2019;22(4):295-302. https://doi.org/10.1097/MCO.0000000000000574
Emous M, Ubels FL, van Beek AP Diagnostic tools for post-gastric bypass hypoglycaemia. Obes Rev. 2015;16(10):843-856. https://doi.org/10.1111/obr.12307
Goldfine AB, Patti ME How common is hypoglycemia after gastric bypass? Obes Silver Spring. 2016;24(6):1210-1211. https://doi.org/10.1002/oby.21520
Fischer LE, Wolfe BM, Fino N, et al. Postbariatric hypoglycemia: symptom patterns and associated risk factors in the Longitudinal Assessment of Bariatric Surgery study. Surg Obes Relat Dis. 2021;17(10):1787-1798. https://doi.org/10.1016/j.soard.2021.04.021
van Furth AM, van den Broek M, Emous M, de Heide LJM, Kuipers F, van Beek AP Cholecystectomy increases the risk of dumping syndrome and postbariatric hypoglycemia after bariatric surgery. Surg Obes Relat Dis. 2020;16(12):1939-1947. https://doi.org/10.1016/j.soard.2020.08.009
Nielsen JB, Pedersen AM, Gribsholt SB, Svensson E, Richelsen B Prevalence, severity, and predictors of symptoms of dumping and hypoglycemia after Roux-en-Y gastric bypass. Surg Obes Relat Dis. 2016;12(8):1562-1568. https://doi.org/10.1016/j.soard.2016.04.017
Sun W, Zhang Y, Shen Q, Zhang W, Yao Q, Yang Y Prevalence and risk factors for symptoms suggestive of hypoglycemia and early dumping syndrome after sleeve gastrectomy. Surg Obes Relat Dis. 2019;15(9):1439-1446. https://doi.org/10.1016/j.soard.2019.06.026
Marsk R, Jonas E, Rasmussen F, Naslund E Nationwide cohort study of post-gastric bypass hypoglycaemia including 5,040 patients undergoing surgery for obesity in 1986-2006 in Sweden. Diabetologia. 2010;53(11):2307-2311. https://doi.org/10.1007/s00125-010-1798-5
Gribsholt SB, Pedersen AM, Svensson E, Thomsen RW, Richelsen B Prevalence of self-reported symptoms after gastric bypass surgery for obesity. JAMA Surg. 2016;151(6):504-511. https://doi.org/10.1001/jamasurg.2015.5110
Brix JM, Kopp HP, Hollerl F, Schernthaner GH, Ludvik B, Schernthaner G Frequency of hypoglycaemia after different bariatric surgical procedures. Obes Facts. 2019;12(4):397-406. https://doi.org/10.1159/000493735
Roslin MS, Oren JH, Polan BN, Damani T, Brauner R, Shah PC Abnormal glucose tolerance testing after gastric bypass. Surg Obes Relat Dis. 2013;9(1):26-31. https://doi.org/10.1016/j.soard.2011.11.023
Goldfine AB, Mun EC, Devine E, et al Patients with neuroglycopenia after gastric bypass surgery have exaggerated incretin and insulin secretory responses to a mixed meal. J Clin Endocrinol Metab. 2007;92(12):4678-4685. https://doi.org/10.1210/jc.2007-0918
Lupoli R, Lembo E, Rainone C, et al Rate of post-bariatric hypoglycemia using continuous glucose monitoring: a meta-analysis of literature studies. Nutr Metab Cardiovasc Dis. 2022;32(1):32-39. https://doi.org/10.1016/j.numecd.2021.08.047
Creutzfeldt W The incretin concept today. Diabetologia. 1979;16(2):75-85. https://doi.org/10.1007/BF01225454
Nguyen NT, Varela JE Bariatric surgery for obesity and metabolic disorders: state of the art. Nat Rev Gastroenterol Hepatol. 2017;14(3):160-169. https://doi.org/10.1038/nrgastro.2016.170
Reubi JC, Perren A, Rehmann R, et al Glucagon-like peptide-1 (GLP-1) receptors are not overexpressed in pancreatic islets from patients with severe hyperinsulinaemic hypoglycaemia following gastric bypass. Diabetologia. 2010;53(12):2641-2645. https://doi.org/10.1007/s00125-010-1901-y
Jorgensen NB, Jacobsen SH, Dirksen C, et al Acute and long-term effects of Roux-en-Y gastric bypass on glucose metabolism in subjects with Type 2 diabetes and normal glucose tolerance. Am J Physiol Endocrinol Metab. 2012;303(1):E122-E131. https://doi.org/10.1152/ajpendo.00073.2012
Salehi M, Gastaldelli A, D'Alessio DA Altered islet function and insulin clearance cause hyperinsulinemia in gastric bypass patients with symptoms of postprandial hypoglycemia. J Clin Endocrinol Metab. 2014;99(6):2008-2017. https://doi.org/10.1210/jc.2013-2686
Calabria AC, Li C, Gallagher PR, Stanley CA, De León DD GLP-1 receptor antagonist exendin-(9-39) elevates fasting blood glucose levels in congenital hyperinsulinism owing to inactivating mutations in the ATP-sensitive K+ channel. Diabetes. 2012;61(10):2585-2591. https://doi.org/10.2337/db12-0166
Mussig K, Staiger H, Machicao F, Haring HU, Fritsche A Genetic variants affecting incretin sensitivity and incretin secretion. Diabetologia. 2010;53(11):2289-2297. https://doi.org/10.1007/s00125-010-1876-8
Lee CJ, Brown T, Magnuson TH, Egan JM, Carlson O, Elahi D Hormonal response to a mixed-meal challenge after reversal of gastric bypass for hypoglycemia. J Clin Endocrinol Metab. 2013;98(7):E1208-E1212. https://doi.org/10.1210/jc.2013-1151
Arora I, Patti ME Can reversal of RYGB also reverse hypoglycemia? Mol Metab. 2018;9:1-3. https://doi.org/10.1016/j.molmet.2018.01.004
Salehi M, Woods SC, D'Alessio DA Gastric bypass alters both glucose-dependent and glucose-independent regulation of islet hormone secretion. Obesity. 2015;23(10):2046-2052. https://doi.org/10.1002/oby.21186
Abrahamsson N, Borjesson JL, Sundbom M, Wiklund U, Karlsson FA, Eriksson JW Gastric bypass reduces symptoms and hormonal responses in hypoglycemia. Diabetes. 2016;65(9):2667-2675. https://doi.org/10.2337/db16-0341
Ohrstrom CC, Hansen DL, Kielgast UL, et al Counterregulatory responses to postprandial hypoglycemia after Roux-en-Y gastric bypass. Surg Obes Relat Dis. 2021;17(1):55-63. https://doi.org/10.1016/j.soard.2020.08.037
Liou AP, Paziuk M, Luevano JM, Jr., Machineni S, Turnbaugh PJ, Kaplan LM Conserved shifts in the gut microbiota due to gastric bypass reduce host weight and adiposity. Sci Transl Med. 2013;5(178):178ra141. https://doi.org/10.1126/scitranslmed.3005687
Patti ME, Houten SM, Bianco AC, et al Serum bile acids are higher in humans with prior gastric bypass: potential contribution to improved glucose and lipid metabolism. Obesity. 2009;17(9):1671-1677. https://doi.org/10.1038/oby.2009.102
Hansen CF, Bueter M, Theis N, et al Hypertrophy dependent doubling of L-cells in Roux-en-Y gastric bypass operated rats. PLoS One. 2013;8(6):e65696. https://doi.org/10.1371/journal.pone.0065696
Gulsrud PO, Taylor IL, Watts HD, Cohen MB, Elashoff J, Meyer JH How gastric emptying of carbohydrate affects glucose tolerance and symptoms after truncal vagotomy with pyloroplasty. Gastroenterology. 1980;78(6):1463-1471. https://doi.org/10.1016/s0016-5085(19)30502-5
Capristo E, Panunzi S, De Gaetano A, et al Incidence of hypoglycemia after gastric bypass vs sleeve gastrectomy: a randomized trial. J Clin Endocrinol Metab. 2018;103(6):2136-2146. https://doi.org/10.1210/jc.2017-01695
Patti ME, McMahon G, Mun EC, et al. Severe hypoglycaemia post-gastric bypass requiring partial pancreatectomy: evidence for inappropriate insulin secretion and pancreatic islet hyperplasia. Diabetologia. 2005;48(11):2236-2240. https://doi.org/10.1007/s00125-005-1933-x
Meier JJ, Butler AE, Galasso R, Butler PC Hyperinsulinemic hypoglycemia after gastric bypass surgery is not accompanied by islet hyperplasia or increased beta-cell turnover. Diabetes Care. 2006;29(7):1554-1559. https://doi.org/10.2337/dc06-0392
Davis DB, Khoraki J, Ziemelis M, Sirinvaravong S, Han JY, Campos GM Roux en Y gastric bypass hypoglycemia resolves with gastric feeding or reversal: confirming a non-pancreatic etiology. Mol Metab. 2018;9:15-27. https://doi.org/10.1016/j.molmet.2017.12.011
McLaughlin T, Peck M, Holst J, Deacon C Reversible hyperinsulinemic hypoglycemia after gastric bypass: a consequence of altered nutrient delivery. J Clin Endocrinol Metab. 2010;95(4):1851-1855. https://doi.org/10.1210/jc.2009-1628
Tack J, Arts J, Caenepeel P, De Wulf D, Bisschops R. Pathophysiology, diagnosis and management of postoperative dumping syndrome. Nat Rev Gastroenterol Hepatol. 2009;6(10):583-590. https://doi.org/10.1038/nrgastro.2009.148
D'Alessio R, Watanabe M, Gallo IF, Manfrini S, Tuccinardi D, Bruni V The gastro-jejunal anastomosis site influences dumping syndrome and weight regain in patients with obesity undergoing Laparoscopic Roux-en-Y Gastric Bypass. Eat Weight Disord. 2021;26(6):1871-1880. https://doi.org/10.1007/s40519-020-01030-2
Aziz A The glycemic index: methodological aspects related to the interpretation of health effects and to regulatory Labeling. J AOAC Int. 2009;92(3):879-887. https://doi.org/10.1093/jaoac/92.3.879
Lembo E, Lupoli R, Ciciola P, et al Implementation of low glycemic index diet together with cornstarch in post-gastric bypass hypoglycemia: two case reports. Nutrients. 2018;10(6):670. https://doi.org/10.3390/nu10060670
Rodriguez Flores M, Cruz Soto RC, Vazquez Velazquez V, Soriano Cortes RR, Aguilar Salinas C, Garcia Garcia E Continuous glucose monitoring in the management of patients after gastric bypass. Endocrinol Diabetes Metab Case Rep. 2019;2019:1-6. https://doi.org/10.1530/EDM-18-0155
Kellogg TA, Bantle JP, Leslie DB, et al Postgastric bypass hyperinsulinemic hypoglycemia syndrome: characterization and response to a modified diet. Surg Obes Relat Dis. 2008;4:492-499. https://doi.org/10.1016/j.soard.2008.05.005
van Meijeren J, Timmer I, Brandts H, Janssen I, Boer H Evaluation of carbohydrate restriction as primary treatment for post-gastric bypass hypoglycemia. Surg Obes Relat Dis. 2017;13(3):404-410. https://doi.org/10.1016/j.soard.2016.11.004
Hanaire H, Bertrand M, Guerci B, Anduze Y, Guillaume E, Ritz P High glycemic variability assessed by continuous glucose monitoring after surgical treatment of obesity by gastric bypass. Diabetes Technol Ther. 2011;13(6):625-630. https://doi.org/10.1089/dia.2010.0203
Heber D, Greenway FL, Kaplan LM, et al Endocrine and nutritional management of the post-bariatric surgery patient: an endocrine society clinical practice guideline. J Clin Endocrinol Metab. 2010;95(11):4823-4843. https://doi.org/10.1210/jc.2009-2128
Moize VL, Pi-Sunyer X, Mochari H, Vidal J Nutritional pyramid for post-gastric bypass patients. Obes Surg. 2010;20(8):1133-1141. https://doi.org/10.1007/s11695-010-0160-9
Allied Health Sciences Section Ad Hoc Nutrition C, Aills L, Blankenship J, Buffington C, Furtado M, Parrott J ASMBS allied health nutritional guidelines for the surgical weight loss patient. Surg Obes Relat Dis. 2008;4(5):S73-S108. https://doi.org/10.1016/j.soard.2008.03.002
Faria SL, Faria OP, Buffington C, de Almeida Cardeal M, Ito MK Dietary protein intake and bariatric surgery patients: a review. Obes Surg. 2011;21(11):1798-1805. https://doi.org/10.1007/s11695-011-0441-y
Bell KJ, Smart CE, Steil GM, Brand-Miller JC, King B, Wolpert HA Impact of fat, protein, and glycemic index on postprandial glucose control in type 1 diabetes: implications for intensive diabetes management in the continuous glucose monitoring era. Diabetes Care. 2015;38(6):1008-1015. https://doi.org/10.2337/dc15-0100
Nguyen NQ, Debreceni TL, Burgstad CM, et al. Effects of fat and protein preloads on pouch emptying, intestinal transit, glycaemia, gut hormones, glucose absorption, blood pressure and gastrointestinal symptoms after roux-en-Y gastric bypass. Obes Surg. 2016;26(1):77-84. https://doi.org/10.1007/s11695-015-1722-7
Jenkins DJ, Gassull MA, Leeds AR, et al Effect of dietary fiber on complications of gastric surgery: prevention of postprandial hypoglycemia by pectin. Gastroenterology. 1977;73(2):215-217. https://doi.org/10.1016/s0016-5085(19)32189-4
Gitzelmann R, Hirsig J Infant dumping syndrome: reversal of symptoms by feeding uncooked starch. Eur J Pediatr. 1986;145(6):504-506. https://doi.org/10.1007/BF02429052
Kneepkens CM, Fernandes J, Vonk RJ Dumping syndrome in children. Diagnosis and effect of glucomannan on glucose tolerance and absorption. Acta Paediatr Scand. 1988;77(2):279-286. https://doi.org/10.1111/j.1651-2227.1988.tb10643.x
Harju E, Larmi TK Efficacy of guar gum in preventing the dumping syndrome. JPEN J Parenter Enteral Nutr. 1983;7(5):470-472. https://doi.org/10.1177/0148607183007005470
Stano S, Alam F, Wu L, et al Effect of meal size and texture on gastric pouch emptying and glucagon-like peptide 1 after gastric bypass surgery. Surg Obes Relat Dis. 2017;13(12):1975-1983. https://doi.org/10.1016/j.soard.2017.09.004
van Beek AP, Emous M, Laville M, Tack J Dumping syndrome after esophageal, gastric or bariatric surgery: pathophysiology, diagnosis, and management. Obes Rev. 2017;18(1):68-85. https://doi.org/10.1111/obr.12467
Shantavasinkul PC, Torquati A, Corsino L Post-gastric bypass hypoglycaemia: a review. Clin Endocrinol. 2016;85(1):3-9. https://doi.org/10.1111/cen.13033
Nguyen NQ, Debreceni TL, Burgstad CM, et al Effects of posture and meal volume on gastric emptying, intestinal transit, oral glucose tolerance, blood pressure and gastrointestinal symptoms after roux-en-Y gastric bypass. Obes Surg. 2015;25(8):1392-1400. https://doi.org/10.1007/s11695-014-1531-4
Suhl E, Anderson-Haynes SE, Mulla C, Patti ME Medical nutrition therapy for post-bariatric hypoglycemia: practical insights. Surg Obes Relat Dis. 2017;13(5):888-896. https://doi.org/10.1016/j.soard.2017.01.025
Zaharieva DP, Riddell MC Caffeine and glucose homeostasis during rest and exercise in diabetes mellitus. Appl Physiol Nutr Metab. 2013;38(8):813-822. https://doi.org/10.1139/apnm-2012-0471
Sivakumar TA Review of the use of acarbose for the treatment of post-prandial syndrome (reactive hypoglycemia). Endocrinol Metab Syndrome. 2012;02(01). https://doi.org/10.4172/2161-1017.S1-010
Ohrstrom CC, Worm D, Hojager A, et al Postprandial hypoglycaemia after Roux-en-Y gastric bypass and the effects of acarbose, sitagliptin, verapamil, liraglutide and pasireotide. Diabetes Obes Metab. 2019;21(9):2142-2151. https://doi.org/10.1111/dom.13796
Rosak C, Nitzsche G, König P, Hofmann U. The effect of the timing and the administration of acarbose on postprandial hyperglycaemia. Diabet Med. 1995;12(11):979-984. https://doi.org/10.1111/j.1464-5491.1995.tb00409.x
Shibao C, Gamboa A, Diedrich A, et al. Acarbose, an alpha-glucosidase inhibitor, attenuates postprandial hypotension in autonomic failure. Hypertension. 2007;50(1):54-61. https://doi.org/10.1161/HYPERTENSIONAHA.107.091355
Sheehan A, Patti ME. Hypoglycemia after upper gastrointestinal surgery: clinical approach to assessment, diagnosis, and treatment. Diabetes Metab Syndr Obes. 2020;13:4469-4482. https://doi.org/10.2147/DMSO.S233078
Ritz P, Vaurs C, Bertrand M, Anduze Y, Guillaume E, Hanaire H Usefulness of acarbose and dietary modifications to limit glycemic variability following Roux-en-Y gastric bypass as assessed by continuous glucose monitoring. Diabetes Technol Ther. 2012;14(8):736-740. https://doi.org/10.1089/dia.2011.0302
Valderas JP, Ahuad J, Rubio L, Escalona M, Pollak F, Maiz A Acarbose improves hypoglycaemia following gastric bypass surgery without increasing glucagon-like peptide 1 levels. Obes Surg. 2012;22(4):582-586. https://doi.org/10.1007/s11695-011-0581-0
Mordes JP, Alonso LC Evaluation, medical therapy, and course of adult persistent hyperinsulinemic hypoglycemia after roux-en-Y gastric bypass surgery: a case series. Endocr Pract. 2015;21(3):237-246. https://doi.org/10.4158/EP14118.OR
Vilarrasa N, Goday A, Rubio MA, et al. Hyperinsulinemic hypoglycemia after bariatric surgery: diagnosis and management experience from a Spanish multicenter registry. Obes Facts. 2016;9(1):41-51. https://doi.org/10.1159/000442764
Moreira RO, Moreira RB, Machado NA, Goncalves TB, Coutinho WF Post-prandial hypoglycemia after bariatric surgery: pharmacological treatment with verapamil and acarbose. Obes Surg. 2008;18(12):1618-1621. https://doi.org/10.1007/s11695-008-9569-9
Goode PN, Farndon JR, Anderson J, Johnston ID, Morte JA Diazoxide in the management of patients with insulinoma. World J Surg. 1986;10(4):586-592. https://doi.org/10.1007/BF01655532
Demirbilek H, Hussain K Congenital hyperinsulinism: diagnosis and treatment update. J Clin Res Pediatr Endocrinol. 2017;9:69-87. https://doi.org/10.4274/jcrpe.2017.S007
Altszuler N, Moraru E, Hampshire J. On the mechanism of diazoxide-induced hyperglycemia. Diabetes. 1977;26(10):931-935. https://doi.org/10.2337/diab.26.10.931
Gonzalez-Gonzalez A, Delgado M, Fraga-Fuentes MD Use of diazoxide in management of severe postprandial hypoglycemia in patient after Roux-en-Y gastric bypass. Surg Obes Relat Dis. 2013;9(1):e18-e19. https://doi.org/10.1016/j.soard.2011.05.010
Mathavan VK, Arregui M, Davis C, Singh K, Patel A, Meacham J Management of postgastric bypass noninsulinoma pancreatogenous hypoglycemia. Surg Endosc. 2010;24(10):2547-2555. https://doi.org/10.1007/s00464-010-1001-6
De Marinis L, Barbarino A Calcium antagonists and hormone release. I. Effects of verapamil on insulin release in normal subjects and patients with islet-cell tumor. Metabolism. 1980;29(7):599-604. https://doi.org/10.1016/0026-0495(80)90103-1
Bas F, Darendeliler F, Demirkol D, Bundak R, Saka N, Gunoz H Successful therapy with calcium channel blocker (nifedipine) in persistent neonatal hyperinsulinemic hypoglycemia of infancy. J Pediatr Endocrinol Metab. 1999;12(6):873-878. https://doi.org/10.1515/jpem.1999.12.6.873
Spanakis E, Gragnoli C Successful medical management of status post-Roux-en-Y-gastric-bypass hyperinsulinemic hypoglycemia. Obes Surg. 2009;19(9):1333-1334. https://doi.org/10.1007/s11695-009-9888-5
Patti ME, McMahon G, Mun EC, et al. Severe hypoglycaemia post-gastric bypass requiring partial pancreatectomy: evidence for inappropriate insulin secretion and pancreatic islet hyperplasia. Diabetologia. 2005;48(11):2236-2240. https://doi.org/10.1007/s00125-005-1933-x
Guemes M, Shah P, Silvera S, et al Assessment of nifedipine therapy in hyperinsulinemic hypoglycemia due to mutations in the ABCC8 gene. J Clin Endocrinol Metab. 2017;102:822-830. https://doi.org/10.1210/jc.2016-2916
Guseva N, Phillips D, Mordes JP Successful treatment of persistent hyperinsulinemic hypoglycemia with nifedipine in an adult patient. Endocr Pract. 2010;16(1):107-111. https://doi.org/10.4158/EP09110.CRR
Ames A, Lago-Hernandez CA, Grunvald E Hypoglycemia after gastric bypass successfully treated with calcium Channel Blockers: two case reports. J Endocr Soc. 2019;3(7):1417-1422. https://doi.org/10.1210/js.2019-00097
Hinnen D Glucagon-like peptide 1 receptor agonists for type 2 diabetes. Diabetes Spectr. 2017;30(3):202-210. https://doi.org/10.2337/ds16-0026
Abrahamsson N, Engstrom BE, Sundbom M, Karlsson FA GLP1 analogs as treatment of postprandial hypoglycemia following gastric bypass surgery: a potential new indication? Eur J Endocrinol. 2013;169(6):885-889. https://doi.org/10.1530/EJE-13-0504
Zhao Z, Tang Y, Hu Y, Zhu H, Chen X, Zhao B. Hypoglycemia following the use of glucagon-like peptide-1 receptor agonists: a real-world analysis of post-marketing surveillance data. Ann Transl Med. 2021;9(18):1482. https://doi.org/10.21037/atm-21-4162
Thornberry NA, Gallwitz B Mechanism of action of inhibitors of dipeptidyl-peptidase-4 (DPP-4). Best Pract Res Clin Endocrinol Metab. 2009;23(4):479-486. https://doi.org/10.1016/j.beem.2009.03.004
Gray JL, Debas HT, Mulvihill SJ Control of dumping symptoms by somatostatin analogue in patients after gastric surgery. Arch Surg. 1991;126(10):1231-1235. discussion 1235-1236. https://doi.org/10.1001/archsurg.1991.01410340073010
Arts J, Caenepeel P, Bisschops R, et al Efficacy of the long-acting repeatable formulation of the somatostatin analogue octreotide in postoperative dumping. Clin Gastroenterol Hepatol. 2009;7(4):432-437. https://doi.org/10.1016/j.cgh.2008.11.025
Tack J, Aberle J, Arts J, et al. Safety and efficacy of pasireotide in dumping syndrome-results from a phase 2, multicentre study. Aliment Pharmacol Ther. 2018;47(12):1661-1672. https://doi.org/10.1111/apt.14664
Ohrstrom CC, Hansen DL, Kielgast UL, Hartmann B, Holst JJ, Worm D A low dose of pasireotide prevents hypoglycemia in roux-en-Y gastric bypass-operated individuals. Obes Surg. 2020;30(4):1605-1610. https://doi.org/10.1007/s11695-019-04248-x
Weckbecker G, Lewis I, Albert R, Schmid HA, Hoyer D, Bruns C Opportunities in somatostatin research: biological, chemical and therapeutic aspects. Nat Rev Drug Discov. 2003;2(12):999-1017. https://doi.org/10.1038/nrd1255
de Heide LJ, Laskewitz AJ, Apers JA Treatment of severe postRYGB hyperinsulinemic hypoglycemia with pasireotide: a comparison with octreotide on insulin, glucagon, and GLP-1. Surg Obes Relat Dis. 2014;10(3):e31-e33. https://doi.org/10.1016/j.soard.2013.11.006
Salehi M, Gastaldelli A, D'Alessio DA. Blockade of glucagon-like peptide 1 receptor corrects postprandial hypoglycemia after gastric bypass. Gastroenterology. 2014;146(3):669-680.e2. https://doi.org/10.1053/j.gastro.2013.11.044
Craig CM, Liu LF, Nguyen T, Price C, Bingham J, McLaughlin TL. Efficacy and pharmacokinetics of subcutaneous exendin (9-39) in patients with post-bariatric hypoglycaemia. Diabetes Obes Metab. 2018;20(2):352-361. https://doi.org/10.1111/dom.13078
Tan M, Lamendola C, Luong R, McLaughlin T, Craig C. Safety, efficacy and pharmacokinetics of repeat subcutaneous dosing of avexitide (exendin 9-39) for treatment of post-bariatric hypoglycaemia. Diabetes Obes Metab. 2020;22(8):1406-1416. https://doi.org/10.1111/dom.14048
Craig CM, Lawler HM, Lee CJE, et al. PREVENT: a randomized, placebo-controlled crossover trial of avexitide for treatment of postbariatric hypoglycemia. J Clin Endocrinol Metab. 2021;106(8):e3235-e3248. https://doi.org/10.1210/clinem/dgab103
Laguna Sanz AJ, Mulla CM, Fowler KM, et al. Design and clinical evaluation of a novel low-glucose prediction algorithm with mini-dose stable glucagon delivery in post-bariatric hypoglycemia. Diabetes Technol Ther. 2018;20(2):127-139. https://doi.org/10.1089/dia.2017.0298
Mulla CM, Zavitsanou S, Laguna Sanz AJ, et al. A randomized, placebo-controlled double-blind trial of a closed-loop glucagon system for postbariatric hypoglycemia. J Clin Endocrinol Metab. 2020;105(4):e1260-e1271. https://doi.org/10.1210/clinem/dgz197
Hepprich M, Wiedemann SJ, Schelker BL, et al. Postprandial hypoglycemia in patients after gastric bypass surgery is mediated by glucose-induced IL-1β. Cell Metab. 2020;31(4):699-709.e5. https://doi.org/10.1016/j.cmet.2020.02.013
Carpentieri GB, Gonçalves SEAB, Casagrande MZ, Mourad WM, Pinto LGC, Zanella MT. SGLT2 inhibition with empagliflozin as a possible therapeutic option for postprandial hypoglycemia after bariatric surgery. Obes Surg. 2022;32(8):2664-2671. https://doi.org/10.1007/s11695-022-06119-4
Bellastella G, Caruso P, Carbone C, et al. Case Report: post-gastrectomy reactive hyperinsulinemic hypoglicaemia: glucose trends before and after canagliflozin treatment. Front Endocrinol. 2023;14:1193696. https://doi.org/10.3389/fendo.2023.1193696
Iqbal QZ, Mishiyev D, Zia Z, Ruggiero RA, Aftab G. Euglycemic diabetic ketoacidosis with sodium-glucose cotransporter-2 inhibitor use post-bariatric surgery: a brief review of the literature. Cureus. 2020;12(10):e10878. https://doi.org/10.7759/cureus.10878
Johnson KW, Neale A, Gordon A, et al. Attenuation of insulin action by an allosteric insulin receptor antibody in healthy volunteers. J Clin Endocrinol Metab. 2017;102(8):3021-3028. https://doi.org/10.1210/jc.2017-00822
Sheehan A, Goldfine A, Bajwa M, et al. Pramlintide for post-bariatric hypoglycaemia. Diabetes Obes Metab. 2022;24(6):1021-1028. https://doi.org/10.1111/dom.14665
Slezak LA, Andersen DK. Pancreatic resection: effects on glucose metabolism. World J Surg. 2001;25(4):452-460. https://doi.org/10.1007/s002680020337
Mulla CM, Storino A, Yee EU, et al. Insulinoma after bariatric surgery: diagnostic dilemma and therapeutic approaches. Obes Surg. 2016;26(4):874-881. https://doi.org/10.1007/s11695-016-2092-5
Dapri G, Cadière GB, Himpens J. Laparoscopic reconversion of Roux-en-Y gastric bypass to original anatomy: technique and preliminary outcomes. Obes Surg. 2011;21(8):1289-1295. https://doi.org/10.1007/s11695-010-0252-6
Clancy TE, Moore FD, Jr, Zinner MJ. Post-gastric bypass hyperinsulinism with nesidioblastosis: subtotal or total pancreatectomy may be needed to prevent recurrent hypoglycemia. J Gastrointest Surg. 2006;10(8):1116-1119. https://doi.org/10.1016/j.gassur.2006.04.008
Z'graggen K, Guweidhi A, Steffen R, et al. Severe recurrent hypoglycemia after gastric bypass surgery. Obes Surg. 2008;18(8):981-988. https://doi.org/10.1007/s11695-008-9480-4
Mala T. Postprandial hyperinsulinemic hypoglycemia after gastric bypass surgical treatment. Surg Obes Relat Dis. 2014;10(6):1220-1225. https://doi.org/10.1016/j.soard.2014.01.010
Ma P, Ghiassi S, Lloyd A, et al. Reversal of Roux en Y gastric bypass: largest single institution experience. Surg Obes Relat Dis. 2019;15(8):1311-1316. https://doi.org/10.1016/j.soard.2019.05.005
Conaty EA, Novak S, Avitia R, Su B, Linn JG, Ujiki MB. Endoscopic gastrojejunal revision (transoral outlet reduction) for persistent hypoglycemia after gastric bypass. Obes Surg. 2019;29(11):3773-3775. https://doi.org/10.1007/s11695-019-04113-x