Preoperative risk factors associated with hypoglycemia after bariatric surgery: a systematic review and meta-analysis

Hypoglycemia is a common adverse outcome after bariatric surgery. Preoperative factors are important to predict worse hypoglycemic incidence. This study aimed to evaluate preoperative risk factors associated with the incidence of hypoglycemia after bariatric surgery.

A systematic search was performed across 3 databases until September 2024. Hypoglycemia was defined as the presence of neuroglycopenic and/or neurogenic signs and symptoms, accompanied by a blood glucose level of <3.0 mmol/L (54 mg/dL) with resolution after glucose ingestion.

A total of 11 observational and randomized controlled trial studies, which were composed of 8428 patients, were included in the study. Female sex (odds ratio [OR] 1.56, [95% CI, 1.28-1.89]; P <.00001; I² = 0%) and body mass index (BMI; OR, 1.03 [95% CI, 1.01-1.05]; P =.002; I² = 0%) were associated with an increased risk of developing hypoglycemia after bariatric surgery. Preoperative fasting blood glucose value was associated with increased odds of hypoglycemia (OR, 3.16 [95% CI, 1.34-7.44]; P =.008; I² = 83%; r, -492 [range, -0.572 to -402]; P =.000). Age, hemoglobin A1C level, high-density lipoprotein cholesterol, triglycerides, and preoperative smoking status were not significantly associated with the increased odds of postbariatric hypoglycemia (PBH) or linearly correlated with the outcome (P >.05).

Female sex, BMI, and preoperative fasting blood glucose level were significantly associated with the incidence of PBH. A lower preoperative fasting blood glucose level increased the risk of PBH.