Continuous Glucose Monitoring in Patients With Postbariatric Hypoglycemia: Effect on Hypoglycemia and Quality of Life

Postbariatric hypoglycemia (PBH), complicating up to one-third of bariatric surgeries, is characterized by repeated episodes of severe hypoglycemia and hypoglycemia unawareness that threaten patient safety and impair quality of life.

We tested the hypothesis that use of a continuous glucose monitor (CGM) would reduce hypoglycemia and improve quality of life in patients with PBH.

In a crossover design, 14 patients with diagnosed PBH were assigned in random order to sequential treatment with unblinded CGM or blinded CGM/no alarms for 10 days each. Glucose and quality of life measures were compared between the 2 periods.

Outpatient.

Hypoglycemia measured by fingerstick blood glucose in response to symptoms or CGM alarm and CGM glucose values; quality of life measures included dietary liberalization and hypoglycemia-related worries/behaviors captured by the Hypoglycemia Fear Survey-II.

Baseline frequency of hypoglycemic events, disability, and hypoglycemia-related worries were high. Symptom-triggered hypoglycemic events confirmed by fingerstick glucose were reduced 6-fold (P = .008) and the glucose nadir measured by CGM was >8 mg/dL higher (P = .005) during unblinded use of CGM compared to the blinded comparison period. Hypoglycemia Fear Survey-II scores improved significantly in response to unblinded CGM use compared to the blinded control period (P = .026). The intake of carbohydrate-containing meals increased without increasing rate of postprandial hyper- or hypoglycemia.

Use of unblinded CGM in patients with PBH reduces frequency and severity of hypoglycemia and improves quality of life by decreasing hypoglycemia-related worries and enabling a less restrictive diet. CGM should be considered a first-line treatment for patients with PBH.