Society for Endocrinology guidelines for the diagnosis and management of post-bariatric hypoglycaemia

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Abstract

Post-bariatric hypoglycaemia (PBH) is typically a post-prandial hypoglycaemia occurring about 2–4 h after eating in individuals who have undergone bariatric surgery. PBH develops relatively late after surgery and often after discharge from post-surgical follow-up by bariatric teams, leading to variability in diagnosis and management in non-specialist centres.

Aim

The overall aim was to improve and standardise clinical practice in the diagnosis and management of PBH. The objectives were: ( 1) to undertake an up-to-date review of the current literature; ( 2) to formulate practical and evidence-based guidance regarding the diagnosis and treatment of PBH; ( 3) to recommend future avenues for research in this condition.

Method

A scoping review was undertaken after an extensive literature search. A consensus on the guidance and confidence in the recommendations was reached by the steering group authors prior to review by key stakeholders.

Outcome

We make pragmatic recommendations for the practical diagnosis and management of PBH, including criteria for diagnosis and recognition, as well as recommendations for research areas that should be explored.

Plain English summary

Post-bariatric hypoglycaemia (PBH) is a condition that commonly affects people who have undergone weight loss surgery. In this condition, people develop low blood sugar occurring about 2–4 h after meals, leading to debilitating symptoms such as hunger, sweating, anxiety, palpitations and even blackouts and fainting. PBH is becoming more common as weight loss surgery is being taken up by more people to help with their weight and to help with diabetes. The condition often develops after the patient has been discharged from follow-up after their surgery, which can lead to inconsistent diagnosis and treatment in non-specialist healthcare centres. The lack of clear information and evidence in the existing scientific literature further contributes to the variation in care. To address this problem, the Society for Endocrinology has created new guidelines to help healthcare professionals accurately diagnose and manage this condition. The guidelines were developed with input from dietitians, surgeons and doctors specialising in weight loss, and hormone specialists.

Related collections

Most cited references 147

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What is "quality of evidence" and why is it important to clinicians?

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Review of the key results from the Swedish Obese Subjects (SOS) trial - a prospective controlled intervention study of bariatric surgery.

L Sjöström (2013)

Obesity is a risk factor for diabetes, cardiovascular disease events, cancer and overall mortality. Weight loss may protect against these conditions, but robust evidence for this has been lacking. The Swedish Obese Subjects (SOS) study is the first long-term, prospective, controlled trial to provide information on the effects of bariatric surgery on the incidence of these objective endpoints. The SOS study involved 2010 obese subjects who underwent bariatric surgery [gastric bypass (13%), banding (19%) and vertical banded gastroplasty (68%)] and 2037 contemporaneously matched obese control subjects receiving usual care. The age of participants was 37-60 years and body mass index (BMI) was ≥34 kg m(-2) in men and ≥38 kg m(-2) in women. Here, we review the key SOS study results published between 2004 and 2012. Follow-up periods varied from 10 to 20 years in different reports. The mean changes in body weight after 2, 10, 15 and 20 years were -23%, -17%, -16% and -18% in the surgery group and 0%, 1%, -1% and -1% in the control group respectively. Compared with usual care, bariatric surgery was associated with a long-term reduction in overall mortality (primary endpoint) [adjusted hazard ratio (HR) = 0.71, 95% confidence interval (CI) 0.54-0.92; P = 0.01] and decreased incidences of diabetes (adjusted HR=0.17; P < 0.001), myocardial infarction (adjusted HR = 0.71; P = 0.02), stroke (adjusted HR=0.66; P = 0.008) and cancer (women: adjusted HR = 0.58; P = 0.0008; men: n.s.]. The diabetes remission rate was increased severalfold at 2 years [adjusted odds ratio (OR) = 8.42; P < 0.001] and 10 years (adjusted OR = 3.45; P < 0.001). Whereas high insulin and/or high glucose at baseline predicted favourable treatment effects, high baseline BMI did not, indicating that current selection criteria for bariatric surgery need to be revised. © 2012 The Association for the Publication of the Journal of Internal Medicine.

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American Association of Clinical Endocrinology Clinical Practice Guideline for the Diagnosis and Management of Nonalcoholic Fatty Liver Disease in Primary Care and Endocrinology Clinical Settings

Kenneth Cusi, Scott Isaacs, Diana Barb … (2022)

To provide evidence-based recommendations regarding the diagnosis and management of nonalcoholic fatty liver disease (NAFLD) and nonalcoholic steatohepatitis (NASH) to endocrinologists, primary care clinicians, health care professionals, and other stakeholders.

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Author and article information

Journal

Journal ID (nlm-ta): Endocr Connect

Journal ID (iso-abbrev): Endocr Connect

Journal ID (hwp): EC

Title: Endocrine Connections

Publisher: Bioscientifica Ltd (Bristol )

ISSN (Electronic): 2049-3614

Publication date (Electronic): 01 April 2024

Publication date (Electronic preprint): 07 March 2024

Publication date Collection: 01 May 2024

Volume: 13

Issue: 5

Electronic Location Identifier: e230285

Affiliations

[1 ]Department of Diabetes and Endocrinology , University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK

[2 ]Endocrinology , Division of Medicine, University College London, London, UK

[3 ]Department of Biomedical Sciences , Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark

[4 ]Department of Medicine , Copenhagen University Hospital – Amager and Hvidovre, Hvidovre, Denmark

[5 ]Section of Endocrinology and Investigative Medicine , Department of Metabolism, Digestion and Reproduction, Faculty of Medicine, Imperial College London, London, UK

[6 ]Department of Dietetics , University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK

[7 ]Faculty of Medicine , Chinese University of Hong Kong, Hong Kong

[8 ]Centre for Endocrinology , Diabetes and Metabolism, Birmingham Health Partners, Birmingham, UK

[9 ]School of Nursing and Midwifery , University of Plymouth, Plymouth, UK

[10 ]Brunel University , London, UK

[11 ]Imperial College Healthcare NHS Trust , St Mary’s Hospital, London, UK

[12 ]Endocrinology , Guys’ and St Thomas’s NHS Foundation Trust, London, UK

[13 ]University of Exeter Medical School , Exeter, UK

[14 ]Portsmouth Hospitals University NHS Trust , Portsmouth, UK

[15 ]Royal Surrey County Hospital , Guildford, UK

[16 ]University Hospitals Sussex NHS Foundation Trust , Worthing, UK

[17 ]King's College Hospital NHS Foundation Trust , London, UK

[18 ]BHF Centre for Cardiovascular Science , Queen’s Medical Research Institute, University of Edinburgh, Edinburgh, UK

[19 ]School of Life Course Sciences , Faculty of Life Sciences and Medicine, King's College London, London, UK

Author notes

Correspondence should be addressed to T M-M Tan: t.tan@ 123456imperial.ac.uk

*(J Hazlehurst, B Khoo, C B Lobato, I Ilesanmi, S Abbott, T Chan, S Pillai, K Maslin, S Purkayastha, B McGowan, R Andrews and T M-M Tan were the Steering Group Authors)

†(E Nicholson, K McCullough, L Albon, R Batterham and G K Dimitriadis were the Steering Group Editors and Members)

‡(S Forbes was the Clinical Chair, G Bewick was the Non-Clinical Chair)