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The efficacy of GLP‐1RAs for the management of postprandial hypoglycemia following bariatric surgery: a systematic review

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Llewellyn, David C., Logan Ellis, Hugh, Aylwin, Simon J. B., Oštarijaš, Eduard, Green, Shauna, Sheridan, William, Chew, Nicholas W. S., le Roux, Carel W. +4 more·2023·Obesity
DOI 10.1002/oby.23600PMC PMC10107620
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Abstract

Objective: Postprandial hyperinsulinemic hypoglycemia with neuroglycopenia is an increasingly recognized complication of Roux‐en‐Y gastric bypass and gastric sleeve surgery that may detrimentally affect patient quality of life. One likely causal factor is glucagon‐like peptide‐1 (GLP‐1), which has an exaggerated rise following ingestion of carbohydrates after bariatric surgery. This paper sought to assess the role of GLP‐1 receptor agonists (GLP‐1RAs) in managing postprandial hypoglycemia following bariatric surgery. Methods: MEDLINE, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), ClinicalTrials.gov , and Scopus were systematically and critically appraised for all peer‐reviewed publications that suitably fulfilled the inclusion criteria established a priori. This systematic review was developed according to the Preferred Reporting Items for Systematic Review and Meta‐Analyses Protocols (PRISMA‐P). It followed methods outlined in the Cochrane Handbook for Systematic Reviews of Interventions and is registered with PROSPERO (International Prospective Register of Systematic Reviews; identifier CRD420212716429). Results and Conclusions: Postprandial hyperinsulinemic hypoglycemia remains a notoriously difficult to manage metabolic complication of bariatric surgery. This first, to the authors' knowledge, systematic review presents evidence suggesting that use of GLP‐1RAs does not lead to an increase of hypoglycemic episodes, and, although this approach may appear counterintuitive, the findings suggest that GLP‐1RAs could reduce the number of postprandial hypoglycemic episodes and improve glycemic variability.

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  • GLP-1RA use in PBH reduces glycemic variability and improves hypoglycemia frequency by saturating GLP-1Rs exogenously, which may prevent endogenous fluctuations.

    “GLP-1RA use in PBH is counterintuitive but has been found to reduce glycemic variability and improve hypoglycemia frequency by saturating the GLP-1Rs exogenously, which may prevent endogenous fluctuations [58].”

    From Non-Diabetic Hypoglycemia: Evaluation and Management in Adults (2025) · cites this paper as [58]

    The Introduction proposes that GLP-1RAs occupy receptors and may block peaks of endogenous GLP-1, potentially reducing glycemic variability and hypoglycemia. The review reports some improvements, but its Results also describe a study with no reduction in episode frequency. The claimed receptor mechanism is a theory, not an established explanation for the observed effects. Page numbers were not provided. (LLM, conf=0.88)

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Cited by

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Authors
Llewellyn, D. C., Logan Ellis, H., Aylwin, S. J. B., Oštarijaš, E., Green, S., Sheridan, W., Chew, N. W. S., le Roux, C. W., Miras, A. D., Patel, A. G., Vincent, R. P., & Dimitriadis, G. K.
Affiliations
  • King's College Hospital NHS Foundation Trust (GB)
  • Department of Endocrinology King's College Hospital NHS Foundation Trust London UK
  • University of Pecs (HU)
  • Queen Elizabeth Hospital (GB)
  • King's College London (GB)
  • National University Heart Centre Singapore (SG)
  • Diabetes Complication Research Centre, School of Medicine and Medical Science UCD Conway Institute, University College Dublin Belfield Ireland
  • Imperial College London (GB)
Corresponding author
Dimitriadis, Georgios K.
ORCID
Venue
Obesity
Publisher
Wiley
Published
2022-12-10
Volume
31
Issue
1
Pages
20-30
ISSN
  • 1930-7381 (ISSN-L)
  • 1930-739X
DOI
10.1002/oby.23600
PMC
PMC10107620
OpenAlex
W4312106483
Cited by
54
References
10
Citations by year
2026: 20 · 2025: 11 · 2024: 13 · 2023: 9 · 2022: 1
FWCI
2.02
Type
journal article
Language
en
Open access
Licence
Locations
  • Obesity (publishedVersion, cc-by-nc)
  • PubMed Central (publishedVersion, cc-by-nc)
  • PubMed (publishedVersion)
  • Warwick Research Archive Portal (University of Warwick) (acceptedVersion)
  • Ulster University Research Portal (Ulster University) (acceptedVersion, cc-by-nc)
  • Research Portal (King's College London) (submittedVersion, cc-by-nc)
  • Spiral (Imperial College London) (submittedVersion, cc-by-nc)
Topics
  • Health Sciences › Medicine › Surgery › Bariatric Surgery and Outcomes
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
Keywords
GLP-1 receptor agonists, postprandial hypoglycemia, bariatric surgery complications, Roux-en-Y gastric bypass, sleeve gastrectomy, neuroglycopenia, glycemic variability, glucagon-like peptide-1
MeSH terms
Glucagon-Like Peptide-1 Receptor, Glucagon-Like Peptide-1 Receptor Agonists, Humans, Hypoglycemia, Quality of Life, Bariatric Surgery

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