Management of Late Dumping Syndrome Induced Hypoglycemia With GLP-1R Agonist

Abstract

Background: Late dumping syndrome is a prominent post-bariatric surgery side effect. Glucose-dependenthyperinsulinemia, induced by elevated gastric inhibitory polypeptide (GIP) and glucagon-likepeptide-1 (GLP-1) levels, leading to 2–3 hours post-prandial hypoglycemia. In literature, several managements are available: dietary changes, glucosidase inhibitor, andsomatostatin analogues. In case of failure of those strategies, partial or total pancreatectomy isindicated. Recently, management using GLP-1R agonists showed promising effect inmanagement of late dumping syndrome induced post-prandial hypoglycemia. (1)AimThe aim of this study was to investigate the effect of using GLP-1R agonists w/o low glycemicindex diet for treating dumping syndromes induced post-prandial hypoglycemia in post bariatricsurgery patients. Methods: A sample of 27 cases (25 females, 2 males) mean age 44.64, SD 10.2 of post-bariatric surgerywere managed using GLP-1R w/o low-glycemic index diet after being diagnosed with the latedumping syndrome induced post-prandial hypoglycemia for duration 1–3 years post-surgery. The27 were sent a survey of 13 questions related to their experience pre-and post-management plan. Results: Out of the 27 patients, 15 responded to the survey. The results showed 100% of the participantsdeveloped episodes of severe symptomatic late dumping syndrome with hypoglycemiasymptoms diagnosed after one and half years of their symptoms. 87% of them experiencedhypoglycemia post meals 2–3 hours.70 % of the participants got hypoglycemia more than 5episodes per week (less than 4.0 mmol/l) which was confirmed by blood glucose monitoring. After starting treatment with GLP-1R agonists with or without low-glycemic index diet, 87% ofthe participants reported that the hypoglycemia episodes were reduced. Out of those 87%participants 46% did not get any hypoglycemia episode and 54% of them experienced 1–2 timeshypoglycemia episodes. Conclusion: The results of the survey showed the successful reduction or prevention of late dumpinghypoglycemia episodes frequency post-bariatric surgery by GLP 1R agonist with or without lowglycemicindex diet.