Impact of Postprandial Hypoglycemia on Weight Loss After Bariatric Surgery

Obes Surg. 2020 Jun;30(6):2266-2273. doi: 10.1007/s11695-020-04465-9.


Introduction: Postprandial hypoglycemia (PPHG) is a well-known complication after bariatric surgery (BS). However, it is not known whether PPHG affects weight loss after BS.

Aims: To assess the impact of PPHG on weight loss after BS in subjects without and with type 2 diabetes mellitus (T2D).

Methods: Data from 338 subjects who had undergone gastric bypass (RYGB) or sleeve gastrectomy (LSG) and were followed up for at least 2 years were analyzed. At each follow-up visit, the patient's anthropometric and biochemical characteristics were recorded and the Edinburgh Questionnaire was performed to evaluate the presence of PPHG symptoms.

Results: Before surgery: younger age and lower BMI predicted PPHG after BS (p = 0.02 and p = 0.0008, respectively). Also, the baseline OGTT indicated that subjects who developed PPHG had an earlier glucose peak and more often had low glucose levels at 2 h compared with the no-PPHG group (p = 0.03 and p = 0.004, respectively). After surgery: Mild-to-moderate PPHG occurred equally after RYGB and LSG (38% vs 25%, p = ns when accounting for confounders), and in T2D who achieved remission and those who did not (29.5% vs 28.6%, ns). At the 2-year follow-up, occurrence of PPHG was independently associated with smaller weight loss (p = 0.0006).

Conclusions: Mild-to-moderate PPHG is a frequent complication after bariatric surgery and results in smaller weight loss after 2 years. Age, baseline BMI, and an earlier glucose peak during OGTT predict PPHG after bariatric surgery.

Keywords: Bariatric surgery; Postprandial hypoglycemia; RYGB; Sleeve gastrectomy; Weight loss.

MeSH terms

  • Bariatric Surgery* / adverse effects
  • Diabetes Mellitus, Type 2* / surgery
  • Gastrectomy / adverse effects
  • Gastric Bypass* / adverse effects
  • Humans
  • Hypoglycemia* / etiology
  • Obesity, Morbid* / surgery
  • Retrospective Studies
  • Treatment Outcome
  • Weight Loss