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

David Llewelyn, Hugh Ellis, Simon Aylwin , Eduard Ostarijas, Shauna Green, William Sheridan, Nicholas WS Chew, Carel W le Roux, Alexander D Miras, Ameet G Patel, Royce Vincent, Georgios K Dimitriadis*

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

12 Citations (Scopus)



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.


MEDLINE, Embase, Cochrane Central Register of Controlled Trials (CENTRAL),, 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.

Original languageEnglish
Pages (from-to)20-30
Number of pages11
Issue number1
Early online date10 Dec 2022
Publication statusPublished - Jan 2023


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