Nicole Patience1, Amanda Sheehan2,3, Cameron Cummings3, Mary Elizabeth Patti4,5,6. 1. Clinic Division, Joslin Diabetes Center, Inc, One Joslin Place, Boston, MA, 02215, USA. Nicole.patience@joslin.harvard.edu. 2. Clinic Division, Joslin Diabetes Center, Inc, One Joslin Place, Boston, MA, 02215, USA. 3. Research Division, Joslin Diabetes Center, Boston, MA, USA. 4. Clinic Division, Joslin Diabetes Center, Inc, One Joslin Place, Boston, MA, 02215, USA. Mary.elizabeth.patti@joslin.harvard.edu. 5. Research Division, Joslin Diabetes Center, Boston, MA, USA. Mary.elizabeth.patti@joslin.harvard.edu. 6. Harvard Medical School, Boston, MA, USA. Mary.elizabeth.patti@joslin.harvard.edu.
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. 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.
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. 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.
Authors: Jonathan Q Purnell; Elizabeth N Dewey; Blandine Laferrère; Faith Selzer; David R Flum; James E Mitchell; Alfons Pomp; Walter J Pories; Thomas Inge; Anita Courcoulas; Bruce M Wolfe Journal: J Clin Endocrinol Metab Date: 2021-03-08 Impact factor: 5.958
Authors: Laura E Fischer; Bruce M Wolfe; Nora Fino; Miriam R Elman; David R Flum; James E Mitchell; Alfons Pomp; Walter J Pories; Jonathan Q Purnell; Mary-Elizabeth Patti Journal: Surg Obes Relat Dis Date: 2021-05-19 Impact factor: 3.709