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Evaluation and Management of Patients Referred for Post-Bariatric Surgery Hypoglycemia at a Tertiary Care Center |
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| Authors: | Cifuentes Lizeth Hurtado Maria D. Cortes Tiffany M. Gonzales Kristen Acosta Andres Shah Meera Collazo-Clavell Maria L. |
| Affiliation: | 1.Precision Medicine for Obesity Program, Mayo Clinic, 200 1st SW, Rochester, MN, 55905, USA ;2.Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, 200 1st SW, Rochester, MN, 55905, USA ;3.Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Department of Medicine, Mayo Clinic Health System, 700 West Av. South, La Crosse, WI, 64601, USA ;4.Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Department of Medicine, Mayo Clinic, 200 1st St SW, Rochester, MN, 55905, USA ;5.Division of Endocrinology, University of Texas Health, San Antonio, TX, 78229, USA ;6.Division of Endocrinology, Diabetes, and Metabolism, University of New Mexico Health Sciences Center, Albuquerque, NM, 87106, USA ; |
| Abstract: | Purpose Following bariatric surgery, patients can develop non-specific symptoms self-described as hypoglycemia. However, confirming hypoglycemia can be technically challenging, and therefore, these individuals are frequently treated empirically. This study aimed to describe what diagnostic evaluation and therapeutic interventions patients referred for post-bariatric surgery hypoglycemia undergo. MethodsRetrospective observational cohort study of patients with a history of bariatric surgery was evaluated for post-bariatric surgery hypoglycemia in a tertiary referral center from 2008 to 2017. We collected demographic and bariatric surgery information, clinical presentation of symptoms referred to as hypoglycemia, laboratory and imaging studies performed to evaluate these symptoms, and symptom management and outcomes. ResultsA total of 60/2450 (2.4%) patients who underwent bariatric surgery were evaluated in the Department of Endocrinology for hypoglycemia-related symptoms. The majority were middle-aged women without type 2 diabetes who had undergone Roux-en-Y gastric bypass. Thirty-nine patients (65%) completed a biochemical assessment for hypoglycemia episodes. Six (10%) had confirmed hypoglycemia by Whipple’s triad, and four (6.7%) met the criteria for post-bariatric surgery hypoglycemia based on clinical and biochemical criteria. All patients were recommended dietary modification as the initial line of treatment, and this intervention resulted in most patients reporting at least some improvement in their symptoms. Eight patients (13%) were prescribed pharmacotherapy, and two patients required additional interventions for symptom control. ConclusionsIn our experience, evaluation for hypoglycemia-related symptoms after bariatric surgery was rare. Hypoglycemia was confirmed in the minority of patients. Even without establishing a diagnosis of hypoglycemia, dietary changes were a helpful strategy for symptom management for most patients. Graphical abstract |
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