# Predictors of Post‐Bariatric Surgery Hypoglycemia: A Multicenter Retrospective Cohort Study

## TL;DR

This study identifies factors that increase the risk of low blood sugar after bariatric surgery, such as being female or having vitamin deficiencies.

## Contribution

The study provides new insights into the risk factors for post-bariatric hypoglycemia using a large multicenter cohort.

## Key findings

- The incidence of post-bariatric hypoglycemia increased over time, reaching 35.4% at 18 months.
- Female sex, vitamin B1/B12 deficiency, and Roux-en-Y gastric bypass surgery were associated with higher PBH risk.
- Having type 2 diabetes and longer diabetes duration were protective against PBH.

## Abstract

Post‐bariatric hypoglycemia (PBH) is a recognized complication that typically occurs within 1–3 years after bariatric surgery. We aimed to identify predictors of PBH in a large multicenter cohort.

This retrospective, multicenter cohort study reviewed the medical records of 952 obese patients (body mass index (BMI) ≥ 35 kg/m2) who underwent Roux‐en‐Y gastric bypass (RYGB) or sleeve gastrectomy (SG) between 2020 and 2024 at three medical centers. PBH in a patient after bariatric surgery was defined as biochemically confirmed hypoglycemia less than 3.0 mmol/L (54 mg/dL) with typical symptoms of hypoglycemia, according to Whipple's triad. PBH incidence was evaluated at 12, 15, and 18 months postoperatively. Multivariable logistic regression was used to estimate adjusted associations with PBH after 12 months.

Cumulative PBH incidence was 25.9% at 12 months, 29.3% at 15 months, and 35.4% at 18 months. Factors associated with increased PBH risk included female sex (Odds Ratio (OR): 1.91, 95% Confidence Interval: 1.11–2.71), high school graduate (OR: 1.61, 95% CI: 1.10–2.11), vitamin B1/B12 deficiency (OR: 1.45, 95% CI: 1.04–1.85), and RYGB surgery (OR: 1.81, 95% CI: 1.11–2.51). Protective factors included having type 2 diabetes (OR: 0.75, 95% CI: 0.55–0.96), higher baseline HbA1c (OR: 0.97, 95% CI: 0.95–0.99), and longer diabetes duration (OR: 0.95, 95% CI: 0.91–0.99).

PBH is a challenging complication after bariatric surgery. Our findings underscore the importance of considering metabolic, sociodemographic, and nutritional factors in assessing the risk of PBH.

Predictors of Post‐Bariatric Surgery Hypoglycemia.