Medical and surgical treatment of postbariatric hypoglycaemia: Retrospective data from daily practice

Loek J.M. de Heide*, Sterre H.T. Wouda, Vincent J.T. Peters, Mirjam Oosterwerff-Suiker, Victor A. Gerdes, Marloes Emous, André P. van Beek

*Corresponding author for this work

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Aim: To evaluate medical and surgical treatment of postbariatric hypoglycaemia (PBH) in daily practice. Materials and Methods: Retrospective data were extracted from medical records from four hospitals. PBH was defined by neuroglycopenic symptoms together with a documented glucose <3.0 mmol/L in the postprandial setting after previous bariatric surgery. Data were scored semiquantitatively on efficacy and side effects by two reviewers independently. Duration of efficacy and of use were calculated. Results: In total, 120 patients were included with a median follow-up of 27 months with a mean baseline age of 41 years, total weight loss of 33% and glucose nadir 2.3 mmol/L. Pharmacotherapy consisted of acarbose, diazoxide, short- and long-acting octreotide and glucagon-like peptide-1 receptor agonist analogues (liraglutide and semaglutide) with an overall efficacy in 45%-75% of patients. Combination therapy with two drugs was used by 30 (25%) patients. The addition of a second drug was successful in over half of the patients. Long-acting octreotide and the glucagon-like peptide-1 receptor agonist analogues scored best in terms of efficacy and side effects with a median duration of use of 35 months for octreotide. Finally, 23 (19%) patients were referred for surgical intervention. Efficacy of the surgical procedures, pouch banding, G-tube placement in remnant stomach and Roux-en-Y gastric bypass reversal, pooled together, was 79% with a median duration of initial effect of 13 months. Conclusions: In daily practice, pharmacotherapy for PBH was successful in half to three quarters of patients. Combination therapy was often of value. One in five patients finally needed a surgical procedure, with overall good results.

Original languageEnglish
Pages (from-to)735-747
Number of pages13
JournalDiabetes, Obesity and Metabolism
Issue number3
Early online date15-Nov-2022
Publication statusPublished - Mar-2023


  • bariatric surgery
  • cohort study
  • hypoglycaemia
  • observational study
  • real-world evidence

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