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

David C Llewellyn, Hugh Logan Ellis, Simon J B Aylwin, Eduard Oštarijaš, Shauna Green, William Sheridan, Nicholas W S Chew, Carel W le Roux, Alexander D Miras, Ameet G Patel, Royce P Vincent, Georgios K Dimitriadis, David C Llewellyn, Hugh Logan Ellis, Simon J B Aylwin, Eduard Oštarijaš, Shauna Green, William Sheridan, Nicholas W S Chew, Carel W le Roux, Alexander D Miras, Ameet G Patel, Royce P Vincent, Georgios K Dimitriadis

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.

Conflict of interest statement

The authors declared no conflict of interest.

© 2022 The Authors. Obesity published by Wiley Periodicals LLC on behalf of The Obesity Society.

Figures

FIGURE 1
FIGURE 1
PRISMA‐P (Preferred Reporting Items for Systematic Review and Meta‐Analyses Protocols) flow diagram of the systemic review, modified from Moher et al. [54] [Color figure can be viewed at wileyonlinelibrary.com]

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