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Medical Nutrition Therapy and Other Approaches to Management of Post-bariatric Hypoglycemia: A Team-Based Approach

  • Metabolism (M Dalamaga, Section Editor)
  • Published:
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Abstract

Purpose of Review

This manuscript provides a review of post-bariatric hypoglycemia (PBH) with a special focus on the role of the registered dietitian-nutritionist (RDN) and medical nutrition therapy (MNT) recommendations as foundational for management.

Recent Findings

As the number of bariatric surgeries rises yearly, with 256,000 performed in 2019, PBH is an increasingly encountered late complication. Following Roux-en-Y (RYGB) or vertical sleeve gastrectomy (VSG), about 1/3 of patients report symptoms suggestive of at least mild postprandial hypoglycemia, with severe and/or medically confirmed hypoglycemia in 1–10%. Anatomical alterations, changes in GLP1 and other intestinally derived hormones, excessive insulin response, reduced insulin clearance, impaired counterregulatory hormone response to hypoglycemia, and other factors contribute to PBH. MNT is the cornerstone of multidisciplinary treatment, with utilization of personal continuous glucose monitoring to improve safety when possible. While many individuals require pharmacotherapy, there are no currently approved medications for PBH.

Summary

Increasing awareness and identification of individuals at risk for or with PBH is critical given the potential impact on safety, nutrition, and quality of life. A team-based approach involving the individual, the RDN, and other clinicians is essential in providing ongoing assessment and individualization of MNT in the long-term management of PBH.

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Funding

MEP gratefully acknowledges grant support related to this project from National Institutes of Health R01 DK121995 and P30 DK036836 (DRC, Joslin Diabetes Center).

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  1. Nicole Patience and Amanda Sheehan are equal contributors.

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  1. Clinic Division, Joslin Diabetes Center, Inc, One Joslin Place, Boston, MA, 02215, USA

    Nicole Patience, Amanda Sheehan & Mary Elizabeth Patti

  2. Research Division, Joslin Diabetes Center, Boston, MA, USA

    Amanda Sheehan, Cameron Cummings & Mary Elizabeth Patti

  3. Harvard Medical School, Boston, MA, USA

    Mary Elizabeth Patti

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NP, AS, and CC declare that they have no conflict of interest related to this manuscript. MEP reports personal fees from Astra Zeneca, Fractyl, Hanmi Pharmaceutical, MBX Biosciences, Recordati, Poxel, Eiger Pharmaceuticals, and Xeris, and grants from Chan-Zuckerberg Initiative, Dexcom, and Helmsley Trust, outside the submitted work.

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Patience, N., Sheehan, A., Cummings, C. et al. Medical Nutrition Therapy and Other Approaches to Management of Post-bariatric Hypoglycemia: A Team-Based Approach. Curr Obes Rep 11, 277–286 (2022). https://doi.org/10.1007/s13679-022-00482-0

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