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- Title
Medical and surgical treatment of postbariatric hypoglycaemia: Retrospective data from daily practice.
- Authors
de Heide, Loek J. M.; Wouda, Sterre H. T.; Peters, Vincent J. T.; Oosterwerff‐Suiker, Mirjam; Gerdes, Victor A.; Emous, Marloes; van Beek, André P.
- Abstract
Aim: To evaluate medical and surgical treatment of postbariatric hypoglycaemia (PBH) in daily practice. Materials and Methods: Retrospective data were extracted from medical records from four hospitals. PBH was defined by neuroglycopenic symptoms together with a documented glucose <3.0 mmol/L in the postprandial setting after previous bariatric surgery. Data were scored semiquantitatively on efficacy and side effects by two reviewers independently. Duration of efficacy and of use were calculated. Results: In total, 120 patients were included with a median follow‐up of 27 months with a mean baseline age of 41 years, total weight loss of 33% and glucose nadir 2.3 mmol/L. Pharmacotherapy consisted of acarbose, diazoxide, short‐ and long‐acting octreotide and glucagon‐like peptide‐1 receptor agonist analogues (liraglutide and semaglutide) with an overall efficacy in 45%‐75% of patients. Combination therapy with two drugs was used by 30 (25%) patients. The addition of a second drug was successful in over half of the patients. Long‐acting octreotide and the glucagon‐like peptide‐1 receptor agonist analogues scored best in terms of efficacy and side effects with a median duration of use of 35 months for octreotide. Finally, 23 (19%) patients were referred for surgical intervention. Efficacy of the surgical procedures, pouch banding, G‐tube placement in remnant stomach and Roux‐en‐Y gastric bypass reversal, pooled together, was 79% with a median duration of initial effect of 13 months. Conclusions: In daily practice, pharmacotherapy for PBH was successful in half to three quarters of patients. Combination therapy was often of value. One in five patients finally needed a surgical procedure, with overall good results.
- Subjects
THERAPEUTICS; HYPOGLYCEMIA; GLUCAGON-like peptide-1 agonists; COMBINATION drug therapy; INSULIN aspart; GASTRIC bypass; GLUCAGON-like peptide-1 receptor
- Publication
Diabetes, Obesity & Metabolism, 2023, Vol 25, Issue 3, p735
- ISSN
1462-8902
- Publication type
Article
- DOI
10.1111/dom.14920