Prevalence of post-bariatric hypoglycemia in the United States

Post-bariatric hypoglycemia (PBH) is a complication of bariatric surgery in which postprandial hypoglycemia can be severe, frequent, and debilitating. The incidence reported in the literature varies from .1% to 75% of all bariatric procedures, largely due to differences in methodologies and definitions used to identify incident cases.

To define the burden of PBH, the incidence and prevalence must be ascertained, with accurate definitions of incident cases used. We performed a systematic review of published literature with the following goals: 1) Outline differences between methodologies and definitions used to determine incidence of PBH; 2) Suggest optimal parameters (Level A criteria) to use in defining incident cases; 3) Suggest PBH disease severity classification system; 4) Estimate incidence by severity level based on studies meeting Level A criteria; 5) Model current U.S. prevalence based on incidence rates, surgical census data, and life-expectancy data.

Based on our Level A studies analysis, nearly 30% of Roux-en-Y gastric bypass (RYGB) patients and 10% of sleeve gastrectomy (SG) patients develop hypoglycemia after surgery, with 12% of RYGB and 5% of SG patients requiring medical attention. This translates to approximately 160,000 requiring medical management and over 30,000 receiving critical care.

This significant burden, together with the highly conflicting incidence estimates in published studies underscores the pressing need for standardized assessment methods that will pave the way for improved quality of research, estimates of health care needs and cost, and development of effective treatments.