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

Research output: Contribution to journalReview articlepeer-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

Original languageEnglish
JournalObesity
Accepted/In press22 Aug 2022

King's Authors

Abstract

Postprandial hyperinsulinaemic hypoglycaemia with neuroglycopenia is an increasingly recognised complication of Roux-en-Y gastric bypass (RYGB) and gastric sleeve surgery and 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. We sought to assess the role of GLP-1 receptor agonists (GLP-1RA) in managing postprandial hypoglycaemia following bariatric surgery.
Medical Literature Analysis and Retrieval System Online (MEDLINE), Excerpta Medica (EMBASE), Cochrane Central Register (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-Analysis Protocols. It followed methods outlined in The Cochrane Handbook for Systematic Reviews of Interventions and is registered with PROSPERO (ID CRD420212716429).
Postprandial hyperinsulinaemic hypoglycaemia remains a notoriously difficult to manage metabolic complication of bariatric surgery. In this first systematic review, we present evidence suggesting that use of GLP-1RA does not lead to an increase of hypoglycaemic episodes and although this approach may appear counterintuitive, our findings suggest that GLP-1RA could reduce the number of postprandial hypoglycaemic episodes and improve glycaemic variability.

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