Postbariatric hypoglycemia: symptom patterns and associated risk factors in the Longitudinal Assessment of Bariatric Surgery study
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Background Postbariatric hypoglycemia (PBH) can be a devastating complication for which current therapies are often incompletely effective. More information is needed regarding frequency, incidence, and risk factors for PBH.Objectives To examine hypoglycemia symptoms following Roux-en-Y gastric bypass (RYGB) and laparoscopic adjustable gastric banding (LAGB) and baseline and in-study risk factors.Setting Multicenter, at 10 US hospitals in 6 geographically diverse clinical centers.Methods A prospective, longitudinal cohort study of adults undergoing RYGB or LAGB as part of clinical care between 2006 and 2009 were recruited and followed until January 31, 2015, with baseline and annual postoperative research assessments. We analyzed baseline prevalence and post-operative incidence and frequency of self-reported hypoglycemia symptoms as well as potential preoperative risk factors.Results In all groups, postoperative prevalence of hypoglycemia symptoms was 38.5%. Symptom prevalence increased postoperatively from 2.8%-36.4% after RYGB in patients without preoperative diabetes (T2D), with similar patterns in prediabetes (4.9%-29.1%). Individuals with T2D had higher baseline hypoglycemia symptoms (28.9%), increasing after RYGB (57.9%). Hypoglycemia symptoms were lower after LAGB, with 39.1% reported hypoglycemia symptoms at only 1 postoperative visit with few (4.0%) having persistent symptoms at 6 or more annual visits. Timing of symptoms was not restricted to the postprandial state. Symptoms of severe hypoglycemia were reported in 2.6-3.6% after RYGB. The dominant risk factor for postoperative symptoms was preoperative symptoms; additionally, baseline selective serotonin (SSRI) and serotonin-norepinephrine (SNRI) reuptake inhibitor use was also associated with increased risk in multivariable analysis. Weight loss and regain were not related to hypoglycemia symptom reporting.Conclusion Hypoglycemia symptoms increase over time after RYGB, particularly in patients without diabetes. In a small percentage, symptoms can be persistent or severe and require hospitalization. Preoperative hypoglycemia symptoms and SSRI/SNRI use in RYGB patients without diabetes is associated with increased risk of symptoms.
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Hypoglycemia is also a frequent complication for people with diabetes who have undergone metabolic surgery, especially Roux-en-Y gastric bypass.
“Hypoglycemia is also a frequent complication for people with diabetes who have undergone metabolic surgery, especially Roux-en-Y gastric bypass (119).”
From 6. Glycemic Goals, Hypoglycemia, and Hyperglycemic Crises: Standards of Care in Diabetes-2026. (2026) · cites this paper as [119]
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Self-citation
- Authors
- Fischer, L. E., Wolfe, B. M., Fino, N., Elman, M. R., Flum, D. R., Mitchell, J. E., Pomp, A., Pories, W. J., Purnell, J. Q., Patti, M.-E., Berk, P. D., Bessler, M., Daud, A., Lobdell, H., Mwelu, J., Schrope, B., Ude, A., Honohan, J., Capasso, M., Costa, R., Dakin, G., Ebel, F., Gagner, M., Hsieh, J., Pomp, A., Strain, G., Bowden, R., Chapman, W., Cundiff, B., Ball, M., Cunningham, E., Dohm, L., Pender, J., Pories, W., Barker, J., Howell, M., Garcia, L., Lancaster, K., Lovaas, E., Mitchell, J. E., Monson, T., Cassady, C., Coburn, E., Moher, E., Deveney, C., Elder, K., Greene, S., Purnell, J., O’Rourke, R., Sorenson, C., Wolfe, B. M., Patterson, E., Raum, W., VanDerWerff, L., Kwiatkowski, J., Courcoulas, A. P., Gourash, W., McCloskey, C. A., Ramanathan, R., Kalarchian, M., Marcus, M., Shirley, E., Turo, A., Flum, D. R., Dellinger, E. P., Khandelwal, S., Stewart, S. D., Cooley, M. M., Blissell, R., Miller, M. J., Thirlby, R., Chang, L., Hunter, J., Moonka, R., Ng, D., Belle, S. H., King, W. C., Martin, D., Mercurio, R., Wahed, A., Averbach, F., Horlick, M., Miles, C. W., Staten, M. A., Yanovski, S. Z., & Kleiner, D. E.
- Affiliations
- University of Oklahoma Health Sciences Center (US)
- Oregon Health & Science University (US)
- Portland State University (US)
- Joslin Diabetes Center (US)
- Corresponding author
- Fischer, Laura E.
- ORCID
- Fischer, Laura E.
- Fino, Nora
- Elman, Miriam R.
- Patti, Mary-Elizabeth
- Bessler, Marc
- Daud, Amna
- Schrope, Beth
- Costa, Ricardo
- Gagner, Michel
- Chapman, William
- O’Rourke, Robert
- Raum, William
- Courcoulas, Anita P.
- Gourash, William
- Kalarchian, Melissa
- Marcus, Marsha
- Shirley, Eleanor
- Dellinger, E. Patchen
- Miller, Megan J.
- Chang, Lily
- Moonka, Ravi
- King, Wendy C.
- Wahed, Abdus
- Staten, Myrlene A.
- Yanovski, Susan Z.
- Kleiner, David E.
- Venue
- Surgery for Obesity and Related Diseases
- Publisher
- Elsevier BV
- Published
- 2021-10
- Volume
- 17
- Issue
- 10
- Pages
- 1787-1798
- ISSN
- 1550-7289 (ISSN-L)
- PMC
- PMC9944569
- OpenAlex
- W3163554007
- Cited by
- 36
- References
- 50
- Citations by year
- 2026: 2 · 2025: 13 · 2024: 9 · 2023: 8 · 2022: 4
- FWCI
- 4.93
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Surgery for Obesity and Related Diseases (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- Irving Medical Center, Columbia University
- National Institutes of Health (P30 DK036836, R01 DK106193, U01 DK114156)
- University of Pittsburgh (U01-DK66585, UL1-RR024153)
- East Carolina University (U01-DK66526)
- Oregon Health and Science University (U01-DK66555)
- University of Washington (M01RR-00037, U01-DK66568)
- Joslin Diabetes Center (R01 DK103842)
- National Institute of Diabetes and Digestive and Kidney Diseases (DCC -U01 DK066557, U01-DK66667, UL1-RR024996)
- Endocrine Society
- Topics
- Health Sciences › Medicine › Surgery › Bariatric Surgery and Outcomes
- Health Sciences › Medicine › Surgery › Minimally Invasive Surgical Techniques
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
- Keywords
- Roux-en-Y gastric bypass
- MeSH terms
- Adult, Humans, Hypoglycemia, Longitudinal Studies, Obesity, Morbid, Prospective Studies, Risk Factors, Gastric Bypass, Treatment Outcome, Bariatric Surgery
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