The efficacy of GLP‐1RAs for the management of postprandial hypoglycemia following bariatric surgery: a systematic review

David C. Llewellyn, Hugh Logan Ellis, Simon J. B. Aylwin, Eduard Oštarijaš, Shauna Green, William Sheridan, Nicholas W. S. Chew, Carel W. le Roux, Alexander D. Miras, Ameet G. Patel, Royce P. Vincent, Georgios K. Dimitriadis

Research output: Contribution to journalReview articlepeer-review

9 Citations (Scopus)
53 Downloads (Pure)


Objective: Postprandial hyperinsulinemic hypoglycemia with neuroglycopenia is an increasingly recognized complication of Roux-en-Y gastric bypass and gastric sleeve surgery that may detrimentally affect patient quality of life. One likely causal factor is glucagon-like peptide-1 (GLP-1), which has an exaggerated rise following ingestion of carbohydrates after bariatric surgery. This paper sought to assess the role of GLP-1 receptor agonists (GLP-1RAs) in managing postprandial hypoglycemia following bariatric surgery. Methods: MEDLINE, Embase, Cochrane Central Register of Controlled Trials (CENTRAL),, and Scopus were systematically and critically appraised for all peer-reviewed publications that suitably fulfilled the inclusion criteria established a priori. This systematic review was developed according to the Preferred Reporting Items for Systematic Review and Meta-Analyses Protocols (PRISMA-P). It followed methods outlined in the Cochrane Handbook for Systematic Reviews of Interventions and is registered with PROSPERO (International Prospective Register of Systematic Reviews; identifier CRD420212716429). Results and Conclusions: Postprandial hyperinsulinemic hypoglycemia remains a notoriously difficult to manage metabolic complication of bariatric surgery. This first, to the authors' knowledge, systematic review presents evidence suggesting that use of GLP-1RAs does not lead to an increase of hypoglycemic episodes, and, although this approach may appear counterintuitive, the findings suggest that GLP-1RAs could reduce the number of postprandial hypoglycemic episodes and improve glycemic variability.

Original languageEnglish
Pages (from-to)20-30
Number of pages11
Issue number1
Early online date10 Dec 2022
Publication statusPublished (in print/issue) - 31 Jan 2023

Bibliographical note

Publisher Copyright:
© 2022 The Authors. Obesity published by Wiley Periodicals LLC on behalf of The Obesity Society.


  • Bariatric Surgery/adverse effects
  • Glucagon-Like Peptide-1 Receptor/agonists
  • Humans
  • Hypoglycemia/etiology
  • Quality of Life


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