Department of Internal Medicine, Main Line Health System/Lankenau Medical Center, 100 E Lancaster Ave, Wynnewood, PA, 19096, USA.
Affiliate, Main Line Health System, Emeritus, University of Pennsylvania, 100 E Lancaster Ave, Wynnewood, PA, 19096, USA.
Obes Surg. 2023 Sep;33(9):2927-2937. doi: 10.1007/s11695-023-06758-1. Epub 2023 Aug 2.
With a rise in obesity and more patients opting for bariatric surgery, it becomes crucial to understand associated complications like postprandial hypoglycemia (PPH). After bariatric surgery, significant changes are seen in insulin sensitivity, beta cell function, glucagon-like peptide 1 (GLP-1) levels, the gut microbiome, and bile acid metabolism. And in a small subset of patients, exaggerated imbalances in these functional and metabolic processes lead to insulin-glucose mismatch and hypoglycemia. The main treatment for PPH involves dietary modifications. For those that do not respond, medications or surgical interventions are considered to reverse some of the imbalances. We present a few case reports of patients that safely tolerated GLP-1 agonists. However, larger randomized control trials are needed to further characterize PPH and understand its treatment.
随着肥胖症的增加和更多患者选择接受减重手术，了解相关并发症（如餐后低血糖症）变得至关重要。在减重手术后，胰岛素敏感性、β细胞功能、胰高血糖素样肽 1 (GLP-1) 水平、肠道微生物组和胆汁酸代谢都会发生显著变化。在一小部分患者中，这些功能和代谢过程的过度失衡会导致胰岛素-葡萄糖不匹配和低血糖症。PPH 的主要治疗方法包括饮食调整。对于那些没有反应的患者，会考虑使用药物或手术干预来逆转一些失衡。我们报告了几例患者安全耐受 GLP-1 激动剂的病例。然而，需要更大规模的随机对照试验来进一步描述 PPH 并了解其治疗方法。
