Dec. 03, 2024
Bariatric surgery is an effective treatment for obesity and improves weight-related metabolic diseases such as type 2 diabetes, hypertension and hyperlipidemia. It also reduces lifetime cardiovascular risk and risk of obesity-related malignancy — and it improves quality of life. A small minority of patients, however, experience complications resulting from bariatric surgery that can negatively impact health.
Postbariatric hypoglycemia (PBH) is an uncommon and challenging condition that primarily occurs after Roux-en-Y gastric bypass. Although estimates of the prevalence of this condition vary, it is generally thought to affect about 10% of patients who undergo gastric bypass, with about 1% developing severe hypoglycemia. Severe hypoglycemia is defined as blood glucose of ≤ 40 mg/dL, or hypoglycemia that requires an emergency room visit or hospitalization.
Epidemiological studies report PBH typically occurs after the first postoperative year, with symptom onset occurring 1 to 3 hours after eating. The postprandial nature of this condition is a key element of the history and differentiates it from other etiologies of hypoglycemia such as malnutrition, hormone deficiency or insulinoma.
Adrian Vella, M.D., with Endocrinology, Diabetes, Metabolism, and Nutrition at Mayo Clinic in Rochester, Minnesota, states: "We see patients with this condition present with a range of symptoms and functional impairments. Often, the first step in clinic is to confirm the diagnosis of hypoglycemia utilizing Whipple's triad. Following that, we discuss specific dietary interventions and the role of other treatment options."
He adds: "We currently have a study underway using subcutaneous pasireotide, a somatostatin analogue. The main goal is to determine how pasireotide changes blood glucose concentrations when compared to placebo during the study period.".
"We hope that the outcome of this study adds to the range of therapeutic options for patients with PBH who sometimes live with recurrent and recalcitrant hypoglycemia impacting overall quality of life," says Dr. Vella.
For more information, please contact Dr. Vella at [email protected].
For more information
Clinical trials: Pasireotide s.c. in Patients With Post-Bariatric Hypoglycaemia. Mayo Clinic.
Refer a patient to Mayo Clinic.