Hypoglycemia After Upper Gastrointestinal Surgery: Clinical Approach to Assessment, Diagnosis, and Treatment
Open accessAbstract
CONTEXT: Post-bariatric hypoglycemia (PBH) is an increasingly encountered complication of upper gastrointestinal surgery; the prevalence of this condition is anticipated to rise given yearly increases in bariatric surgical procedures. While PBH is incompletely understood, there is a growing body of research describing the associated factors, mechanisms, and treatment approaches for this condition. EVIDENCE ACQUISITION: Data are integrated and summarized from studies of individuals affected by PBH and hypoglycemia following upper gastrointestinal surgery obtained from PubMed searches (1990-2020). EVIDENCE SYNTHESIS: Information addressing etiology, incidence/prevalence, clinical characteristics, assessment, and treatment were reviewed and synthesized for the practicing physician. Literature reports were supplemented by clinical experience as indicated, when published data were not available. CONCLUSION: PBH can be life-altering and severe for a subset of individuals. Given the chronic nature of this condition, and sequelae of both acute and recurrent episodes, increasing provider awareness of both the condition and associated risk factors is critical for assessment, prompt diagnosis, treatment, and preoperative identification of individuals at risk.
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Blood glucose sampling, symptom tracking, and meal recordings were the primary data that patients need to collect to observe and mitigate PBH events.
“From the literature review of the previous step, 11 it has emerged that blood glucose sampling, symptom tracking, and meal recordings were the primary data that patients need to collect to observe and mitigate PBH events shortcoming.”
From Design and Usability Assessment of a User-Centered, Modular Platform for Real-World Data Acquisition in Clinical Trials Involving Post-Bariatric Surgery Patients (2025) · cites this paper as [11]
The Diagnosis section (page unavailable) recommends 7–10 days of continuous glucose monitoring alongside a diary of food, activity, and symptoms to identify glycemic patterns and hypoglycemia triggers. It does not call these the primary data patients need to collect generally, and it distinguishes CGM from blood sampling required to establish a diagnosis. (LLM, conf=0.83)
Experimental — accuracy not yet measuredPrevious studies for data collection in PBH individuals mainly relied on paper-based non-structured methods, without integration with automatic glucose data acquisition from CGM sensors.
“These investigations revealed that previous studies for data collection in PBH individuals mainly relied on paper-based non-structured methods, without any integration with the automatic acquisition of glucose data performed with the CGM sensor.”
From Design and Usability Assessment of a User-Centered, Modular Platform for Real-World Data Acquisition in Clinical Trials Involving Post-Bariatric Surgery Patients (2025) · cites this paper as [11]
The Diagnosis section describes PBH patients keeping a diary of food, activity, and symptoms. It does not say that previous studies mainly used paper-based, unstructured methods; instead, it describes linking diary events to glucose patterns recorded by CGM. No page number is available in our copy. (LLM, conf=0.82)
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References 105 · Cited by 39
- Authors
- Sheehan, A., & Patti, M. E.
- Affiliations
- Joslin Diabetes Center (US)
- Corresponding author
- Patti, Mary Elizabeth
- Venue
- Diabetes, Metabolic Syndrome and Obesity: Targets and Therapy
- Publisher
- Informa UK Limited
- Published
- 2020-11
- Volume
- Volume 13
- Pages
- 4469-4482
- ISSN
- 1178-7007 (ISSN-L)
- PMC
- PMC7682607
- OpenAlex
- W3099072068
- Cited by
- 39
- References
- 105
- Citations by year
- 2026: 3 · 2025: 10 · 2024: 4 · 2023: 10 · 2022: 10 · 2021: 2
- FWCI
- 1.25
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- Diabetes Metabolic Syndrome and Obesity (publishedVersion, cc-by-nc)
- PubMed Central (publishedVersion, cc-by-nc)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Dove Medical Press (Taylor and Francis Group) (submittedVersion, cc-by-nc)
- Funders
- Joslin Diabetes Center (P30DK036836, DK036836)
- National Institutes of Health (NIH-R01, DK036836, DK114156)
- National Institute of Diabetes and Digestive and Kidney Diseases (U01DK114156, R01DK121995, R01DK106193, P30DK036836)
- Topics
- Health Sciences › Medicine › Surgery › Bariatric Surgery and Outcomes
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
- Health Sciences › Medicine › Surgery › Minimally Invasive Surgical Techniques
- Keywords
- post-bariatric hypoglycemia, upper gastrointestinal surgery, bariatric surgery complications, hypoglycemia diagnosis, hypoglycemia treatment, risk factors, preoperative risk assessment, recurrent hypoglycemia
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