Predictors of Post-Bariatric Surgery Hypoglycemia: A Multicenter Retrospective Cohort Study
Mansour Bahardoust1, Ali Ranjbarpazuki2, Mohammadsadra Shamohammadi3
1Department of Epidemiology, School of Public Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Endocrinology, Diabetes & Metabolism
|November 9, 2025
Summary
Post-bariatric hypoglycemia (PBH) affects over 35% of patients within 18 months. Female sex, lower education, and vitamin deficiencies increase risk, while type 2 diabetes offers protection.
Area of Science:
- Endocrinology
- Metabolic Surgery
- Clinical Nutrition
Background:
- Post-bariatric hypoglycemia (PBH) is a significant complication following bariatric surgery.
- PBH typically manifests 1-3 years after procedures like Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG).
Purpose of the Study:
- To identify predictors of PBH in a large, multicenter cohort of bariatric surgery patients.
- To analyze sociodemographic, metabolic, and nutritional factors associated with PBH development.
Main Methods:
- Retrospective analysis of 952 obese patients (BMI ≥35 kg/m²) undergoing RYGB or SG.
- PBH defined by Whipple's triad: biochemical hypoglycemia (<3.0 mmol/L) with symptoms.
- Multivariable logistic regression used to assess risk factors at 12, 15, and 18 months post-surgery.
Main Results:
- Cumulative PBH incidence reached 35.4% by 18 months.
- Increased PBH risk linked to female sex, high school education, vitamin B1/B12 deficiency, and RYGB.
- Protective factors included type 2 diabetes, higher baseline HbA1c, and longer diabetes duration.
Conclusions:
- PBH is a common and complex complication after bariatric surgery.
- Metabolic, sociodemographic, and nutritional factors are crucial for assessing PBH risk.
- Further research and targeted interventions are needed to mitigate PBH.
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