Lath D, Cherian KE, Paul TV, Kapoor N. Beyond diabetes remission a step further: Post bariatric surgery hypoglycemia. World J Diabetes 2022; 13(3): 278-281 [PMID: 35432756 DOI: 10.4239/wjd.v13.i3.278]
Corresponding Author of This Article
Nitin Kapoor, MD, PhD, Professor, Department of Endocrinology, Diabetes and Metabolism, Christian Medical College and Hospital, Main Block Ida Scudder Road, Vellore 632004, Tamil Nadu, India. nitin.endocrine@gmail.com
Research Domain of This Article
Endocrinology & Metabolism
Article-Type of This Article
Letter to the Editor
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Diabetes. Mar 15, 2022; 13(3): 278-281 Published online Mar 15, 2022. doi: 10.4239/wjd.v13.i3.278
Beyond diabetes remission a step further: Post bariatric surgery hypoglycemia
Devraj Lath, Kripa Elizabeth Cherian, Thomas Vizhalil Paul, Nitin Kapoor
Devraj Lath, Kripa Elizabeth Cherian, Thomas Vizhalil Paul, Nitin Kapoor, Department of Endocrinology, Diabetes and Metabolism, Christian Medical College and Hospital, Vellore 632004, Tamil Nadu, India
Nitin Kapoor, Non Communicable Disease Unit, Nossal Institute of Global Health, Melbourne 3053, Victoria, Australia
Nitin Kapoor, The Baker Heart and Diabetes Institute, Melbourne 3004, Victoria, Australia
Author contributions: Kapoor N conceived of the presented idea and provided critical feedback to the final manuscript; Lath D wrote the manuscript; Cherian K and Paul TV approved the main conceptual ideas and proof outline; all authors provided final edits and approved the manuscript.
Conflict-of-interest statement: No conflict of interest.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Nitin Kapoor, MD, PhD, Professor, Department of Endocrinology, Diabetes and Metabolism, Christian Medical College and Hospital, Main Block Ida Scudder Road, Vellore 632004, Tamil Nadu, India. nitin.endocrine@gmail.com
Received: September 24, 2021 Peer-review started: September 24, 2021 First decision: January 12, 2022 Revised: January 21, 2022 Accepted: February 23, 2022 Article in press: February 23, 2022 Published online: March 15, 2022
Abstract
Postbariatric hypoglycemia is a rare but increasingly recognized complication of bariatric surgery, with significant associated morbidity, and many patients often require multimodal treatment. A mixed meal challenge test is often helpful to diagnose this condition. This manuscript highlights the underlying mechanisms that lead to this condition and the novel emerging therapeutic targets that target these mechanisms.
Core Tip: Postbariatric hypoglycemia is an uncommon complication presenting months to years after bariatric surgery (mostly in Roux-en-Y gastric bypasses) as postprandial hyperinsulinemic hypoglycaemia occurring 1-3 h after meals, and the associated neuroglycopenic symptoms can be incapacitating. Medical nutrition therapy forms the foundation of management, with pharmacotherapy and surgical interventions available for those who do not respond. An increased understanding of the implicated mechanisms has led to the development of targeted agents like avexitide, which has demonstrated good efficacy in a Phase 2 clinical trial (PREVENT) recently.
