GLP1 analogs as treatment of postprandial hypoglycemia following gastric bypass surgery: A potential new indication?
Abstract
OBJECTIVE: The number of morbidly obese subjects submitted to bariatric surgery is rising worldwide. In a fraction of patients undergoing gastric bypass (GBP), episodes with late postprandial hypoglycemia (PPHG) develop 1-3 years after surgery. The pathogenesis of this phenomenon is not fully understood; meal-induced rapid and exaggerated increases of circulating incretins and insulin appear to be at least partially responsible. Current treatments include low-carbohydrate diets, inhibition of glucose intestinal uptake, reduction of insulin secretion with calcium channel blockers, somatostatin analogs, or diazoxide, a KATP channel opener. Even partial pancreatectomy has been advocated. In type 2 diabetes, GLP1 analogs have a well-documented effect of stabilizing glucose levels without causing hypoglycemia. DESIGN: We explored GLP1 analogs as open treatment in five consecutive GBP cases seeking medical attention because of late postprandial hypoglycemic symptoms. RESULTS: Glucose measured in connection with the episodes in four of the cases had been 2.7, 2.5, 1.8, and 1.6 mmol/l respectively. The patients consistently described that the analogs eliminated their symptoms, which relapsed in four of the five patients when treatment was reduced/discontinued. The drug effect was further documented in one case by repeated 24-h continuous glucose measurements. CONCLUSION: These open, uncontrolled observations suggest that GLP1 analogs might provide a new treatment option in patients with problems of late PPHG.
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GLP-1 analogues may actually stabilize glucose levels in patients with postprandial hypoglycemia after gastric bypass surgery.
“An additional study suggests that GLP-1 analogues may actually stabilize glucose levels in patients with postprandial hypoglycemia after gastric bypass surgery (30).”
From Dumping syndrome after esophageal, gastric or bariatric surgery: Pathophysiology, diagnosis, and management (2017) · cites this paper as [30]
The risk of hypoglycemia during therapy with GLP-1 analogs is very low.
“Nevertheless, the risk of hypoglycemia during therapy with GLP-1 analogs is very low.”
From Hypoglycemia Unawareness—A Review on Pathophysiology and Clinical Implications (2024) · cites this paper as [15]
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- Authors
- Abrahamsson, N., Engström, B. E., Sundbom, M., & Karlsson, F. A.
- Affiliations
- University Hospital (CA)
- Uppsala University (SE)
- Corresponding author
- Karlsson, F Anders
- Venue
- European Journal of Endocrinology
- Publisher
- Oxford University Press (OUP)
- Published
- 2013-12
- Volume
- 169
- Issue
- 6
- Pages
- 885-889
- ISSN
- 0804-4643 (ISSN-L)
- 1479-683X
- OpenAlex
- W2168804523
- Cited by
- 99
- References
- 24
- Citations by year
- 2026: 6 · 2025: 6 · 2024: 13 · 2023: 6 · 2022: 9 · 2021: 8 · 2020: 12 · 2019: 10 · 2018: 5 · 2017: 6 · 2016: 7 · 2015: 8 · 2014: 3
- FWCI
- 5.91
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- European Journal of Endocrinology (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Surgery › Bariatric Surgery and Outcomes
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
- Keywords
- GLP-1 receptor agonists, postprandial hypoglycemia, gastric bypass, bariatric surgery complications, morbid obesity, incretins, insulin secretion, type 2 diabetes, continuous glucose monitoring, new drug indications
- MeSH terms
- Adult, Blood Glucose, Diabetes Mellitus, Type 2, Female, Humans, Hypoglycemia, Male, Middle Aged, Obesity, Morbid, Gastric Bypass, Treatment Outcome, Postprandial Period, Glucagon-Like Peptide 1, Incretins
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