Postbariatric Surgery Hypoglycemia

Excerpt

Obesity is a common, chronic, and often relapsing disease characterized by excess adipose tissue accumulation. The World Health Organization (WHO) considers a body mass index (BMI) ≥30 kg/m as obese and defines severe obesity as a BMI of 40 or higher (also classified as Class 3 obesity).

According to the National Nutritional Health and Examination Survey (NHANES) data (2017 to 2020), the prevalence of obesity among children and adolescents aged 2 to 19 years is 19.7%; among adults aged 20 and over, the age-adjusted prevalence of obesity is 41.9%, and the prevalence of severe obesity is 9.2%. Obesity increases the risk of other medical conditions such as diabetes mellitus type 2, fatty liver disease, hypertension, coronary artery disease, stroke, dementia, obstructive sleep apnea, osteoarthritis, dysthymia, etc. According to the Centers for Disease Control and Prevention (CDC), the estimated annual obesity-related medical care cost was approximately $173 billion in 2019.

Bariatric surgery has been reported to help achieve more significant and sustained weight loss than non-surgical management in patients with severe obesity. According to data from the American Society for Metabolic and Bariatric Surgery (ASMBS), the number of bariatric surgeries performed has increased yearly from 2011 through 2019. Hence, it is essential to be aware of post-surgery adverse events.

Post-bariatric surgery hypoglycemia is an increasingly recognized complication. It has been referred to as late dumping syndrome, reactive hypoglycemia, or postprandial hyper-insulinemic hypoglycemia. However, there is no specific definition of post-bariatric surgery hypoglycemia. It has been thought of as a condition characterized by symptoms of hypoglycemia occurring after a meal in individuals who have undergone weight loss surgery. However, with more sensitive methods, such as continuous glucose monitoring (CGM), other patterns of hypoglycemia are being identified. Post-bariatric surgery hypoglycemia is commonly associated with Roux-en-Y gastric bypass (RYGB) surgery. However, it can also occur with different types of bariatric surgeries, such as sleeve gastrectomy (SG) and laparoscopically adjustable gastric band (LAGB).