Predictors of Hypoglycemia after Bariatric Surgery: a Systematic Review

Abstract

Background: Bariatric surgery is a well-established treatment for obesity, offering substantial benefits in weight loss and metabolic improvements. However, post-bariatric hypoglycemia (PBH) has emerged as a concerning complication, affecting a significant proportion of patients. Understanding its incidence, predictors, and implications is crucial for optimizing patient care. Methods: A systematic review was conducted following PRISMA guidelines. Studies were screened from the PubMed, Scopus, and Web of Science databases, with data extraction and quality assessment performed independently by reviewers. Eligible studies assessed patients who underwent bariatric surgery and documented hypoglycemia. The primary outcome was the incidence of hypoglycemia. Results: Eleven studies were included, encompassing 5340 patients across various countries and surgical techniques, namely Roux-en-Y Gastric Bypass (RYGB), Laparoscopic Sleeve Gastrectomy (LSG), and Laparoscopic Adjustable Gastric Banding (LAGB). Post-bariatric-surgery incidence of hypoglycemia ranged from 7.9% to 61.7%. Younger age, lower pre-surgery BMI, and greater weight loss emerged as predictors of PBH. Preoperative symptoms of hypoglycemia correlated with postoperative occurrences. Conclusion: PBH poses significant clinical challenges, emphasizing the need for comprehensive preoperative evaluation and vigilant postoperative monitoring. Further research with longer follow-up durations and comparative analyses between surgical techniques is warranted to enhance understanding and management of PBH.