The efficacy of GLP-1RAs for the management of postprandial hypoglycemia following bariatric surgery: a systematic review

David Llewelyn; Hugh Ellis; Simon Aylwin; Eduard  Ostarijas; Shauna Green; William Sheridan; Nicholas WS Chew; Carel W le Roux; Alexander D  Miras; Ameet G  Patel; Royce Vincent; Georgios K Dimitriadis

doi:10.1002/oby.23600

The efficacy of GLP-1RAs for the management of postprandial hypoglycemia following bariatric surgery: a systematic review

David Llewelyn, Hugh Ellis, Simon Aylwin , Eduard Ostarijas, Shauna Green, William Sheridan, Nicholas WS Chew, Carel W le Roux, Alexander D Miras, Ameet G Patel, Royce Vincent, Georgios K Dimitriadis^*

^*Corresponding author for this work

Diabetes

Research output: Contribution to journal › Review article › peer-review

15 Citations (Scopus)

Abstract

Objective

Postprandial hyperinsulinemic hypoglycemia with neuroglycopenia is an increasingly recognized complication of Roux-en-Y gastric bypass and gastric sleeve surgery that may detrimentally affect patient quality of life. One likely causal factor is glucagon-like peptide-1 (GLP-1), which has an exaggerated rise following ingestion of carbohydrates after bariatric surgery. This paper sought to assess the role of GLP-1 receptor agonists (GLP-1RAs) in managing postprandial hypoglycemia following bariatric surgery.

Methods

MEDLINE, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), ClinicalTrials.gov, and Scopus were systematically and critically appraised for all peer-reviewed publications that suitably fulfilled the inclusion criteria established a priori. This systematic review was developed according to the Preferred Reporting Items for Systematic Review and Meta-Analyses Protocols (PRISMA-P). It followed methods outlined in the Cochrane Handbook for Systematic Reviews of Interventions and is registered with PROSPERO (International Prospective Register of Systematic Reviews; identifier CRD420212716429).

Results and Conclusions

Postprandial hyperinsulinemic hypoglycemia remains a notoriously difficult to manage metabolic complication of bariatric surgery. This first, to the authors' knowledge, systematic review presents evidence suggesting that use of GLP-1RAs does not lead to an increase of hypoglycemic episodes, and, although this approach may appear counterintuitive, the findings suggest that GLP-1RAs could reduce the number of postprandial hypoglycemic episodes and improve glycemic variability.

Original language	English
Pages (from-to)	20-30
Number of pages	11
Journal	Obesity
Volume	31
Issue number	1
Early online date	10 Dec 2022
DOIs	https://doi.org/10.1002/oby.23600
Publication status	Published - Jan 2023

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@article{439b391d7739420e833a724d3bf7b984,

title = "The efficacy of GLP-1RAs for the management of postprandial hypoglycemia following bariatric surgery: a systematic review",

abstract = "ObjectivePostprandial hyperinsulinemic hypoglycemia with neuroglycopenia is an increasingly recognized complication of Roux-en-Y gastric bypass and gastric sleeve surgery that may detrimentally affect patient quality of life. One likely causal factor is glucagon-like peptide-1 (GLP-1), which has an exaggerated rise following ingestion of carbohydrates after bariatric surgery. This paper sought to assess the role of GLP-1 receptor agonists (GLP-1RAs) in managing postprandial hypoglycemia following bariatric surgery.MethodsMEDLINE, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), ClinicalTrials.gov, and Scopus were systematically and critically appraised for all peer-reviewed publications that suitably fulfilled the inclusion criteria established a priori. This systematic review was developed according to the Preferred Reporting Items for Systematic Review and Meta-Analyses Protocols (PRISMA-P). It followed methods outlined in the Cochrane Handbook for Systematic Reviews of Interventions and is registered with PROSPERO (International Prospective Register of Systematic Reviews; identifier CRD420212716429).Results and ConclusionsPostprandial hyperinsulinemic hypoglycemia remains a notoriously difficult to manage metabolic complication of bariatric surgery. This first, to the authors' knowledge, systematic review presents evidence suggesting that use of GLP-1RAs does not lead to an increase of hypoglycemic episodes, and, although this approach may appear counterintuitive, the findings suggest that GLP-1RAs could reduce the number of postprandial hypoglycemic episodes and improve glycemic variability.",

author = "David Llewelyn and Hugh Ellis and Simon Aylwin and Eduard Ostarijas and Shauna Green and William Sheridan and Chew, {Nicholas WS} and {le Roux}, {Carel W} and Miras, {Alexander D} and Patel, {Ameet G} and Royce Vincent and Dimitriadis, {Georgios K}",

note = "Publisher Copyright: {\textcopyright} 2022 The Authors. Obesity published by Wiley Periodicals LLC on behalf of The Obesity Society.",

year = "2023",

month = jan,

doi = "10.1002/oby.23600",

language = "English",

volume = "31",

pages = "20--30",

journal = "Obesity",

issn = "1930-7381",

publisher = "Wiley-Blackwell",

number = "1",

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TY - JOUR

T1 - The efficacy of GLP-1RAs for the management of postprandial hypoglycemia following bariatric surgery

T2 - a systematic review

AU - Llewelyn, David

AU - Ellis, Hugh

AU - Aylwin , Simon

AU - Ostarijas, Eduard

AU - Green, Shauna

AU - Sheridan, William

AU - Chew, Nicholas WS

AU - le Roux, Carel W

AU - Miras, Alexander D

AU - Patel, Ameet G

AU - Vincent, Royce

AU - Dimitriadis, Georgios K

PY - 2023/1

Y1 - 2023/1

N2 - ObjectivePostprandial hyperinsulinemic hypoglycemia with neuroglycopenia is an increasingly recognized complication of Roux-en-Y gastric bypass and gastric sleeve surgery that may detrimentally affect patient quality of life. One likely causal factor is glucagon-like peptide-1 (GLP-1), which has an exaggerated rise following ingestion of carbohydrates after bariatric surgery. This paper sought to assess the role of GLP-1 receptor agonists (GLP-1RAs) in managing postprandial hypoglycemia following bariatric surgery.MethodsMEDLINE, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), ClinicalTrials.gov, and Scopus were systematically and critically appraised for all peer-reviewed publications that suitably fulfilled the inclusion criteria established a priori. This systematic review was developed according to the Preferred Reporting Items for Systematic Review and Meta-Analyses Protocols (PRISMA-P). It followed methods outlined in the Cochrane Handbook for Systematic Reviews of Interventions and is registered with PROSPERO (International Prospective Register of Systematic Reviews; identifier CRD420212716429).Results and ConclusionsPostprandial hyperinsulinemic hypoglycemia remains a notoriously difficult to manage metabolic complication of bariatric surgery. This first, to the authors' knowledge, systematic review presents evidence suggesting that use of GLP-1RAs does not lead to an increase of hypoglycemic episodes, and, although this approach may appear counterintuitive, the findings suggest that GLP-1RAs could reduce the number of postprandial hypoglycemic episodes and improve glycemic variability.

AB - ObjectivePostprandial hyperinsulinemic hypoglycemia with neuroglycopenia is an increasingly recognized complication of Roux-en-Y gastric bypass and gastric sleeve surgery that may detrimentally affect patient quality of life. One likely causal factor is glucagon-like peptide-1 (GLP-1), which has an exaggerated rise following ingestion of carbohydrates after bariatric surgery. This paper sought to assess the role of GLP-1 receptor agonists (GLP-1RAs) in managing postprandial hypoglycemia following bariatric surgery.MethodsMEDLINE, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), ClinicalTrials.gov, and Scopus were systematically and critically appraised for all peer-reviewed publications that suitably fulfilled the inclusion criteria established a priori. This systematic review was developed according to the Preferred Reporting Items for Systematic Review and Meta-Analyses Protocols (PRISMA-P). It followed methods outlined in the Cochrane Handbook for Systematic Reviews of Interventions and is registered with PROSPERO (International Prospective Register of Systematic Reviews; identifier CRD420212716429).Results and ConclusionsPostprandial hyperinsulinemic hypoglycemia remains a notoriously difficult to manage metabolic complication of bariatric surgery. This first, to the authors' knowledge, systematic review presents evidence suggesting that use of GLP-1RAs does not lead to an increase of hypoglycemic episodes, and, although this approach may appear counterintuitive, the findings suggest that GLP-1RAs could reduce the number of postprandial hypoglycemic episodes and improve glycemic variability.

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U2 - 10.1002/oby.23600

DO - 10.1002/oby.23600

M3 - Review article

C2 - 36502288

AN - SCOPUS:85144079137

SN - 1930-7381

VL - 31

SP - 20

EP - 30

JO - Obesity

JF - Obesity

IS - 1

ER -

The efficacy of GLP-1RAs for the management of postprandial hypoglycemia following bariatric surgery: a systematic review

Abstract

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