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

Background: post-bariatric hypoglycemia is a significant concern for patients and physicians, usually occurring within 1-3 years after surgery. Several factors may be associated with PBH. The aim of this study was to evaluate the predictors of PBH after surgery. Methods: In this retrospective cohort study, the medical profiles of 1009 obese patients (BMI≥30 kg/m2) who underwent surgery with one of the RYGB, OAGB, or SG techniques at one of three medical centers affiliated with [BLINDED FOR REVIEW] between 2020 and 2024 were reviewed. Patients were divided into two groups based on the incidence of PBH. The incidence of PBH was defined based on ICD-10-CM diagnosis codes (E16.1, E16.2) or laboratory values (glucose ≤ 70 mg/dL) during the follow-up period. The incidence of PBH was estimated 1, 3, 6, and 12 months after surgery. Predictors of PBH were evaluated by multivariate logistic regression analysis. Results: The incidence of PBH at 3, 6, and 12 months after surgery was 261 (25.9%), 296(29.3%), and 357(35.4%), respectively. Multivariate analysis showed that female gender (OR _Adjusted : 1.91, 95 % CI: 1.11, 2.71), education level <high school(OR _Adjusted : 1.61, 95 % CI: 1.1, 2.11), insulin versus oral antidiabetic drugs (OR _Adjusted : 2.6, 95 % CI: 1.5, 3.7), vitamin deficiency(OR _Adjusted : 1.45, 95 % CI: 1.04, 1.85), and RYGB surgery (OR _Adjusted : 1.81, 95 % CI: 1.11, 2.51)were significantly associated with an increased risk of PBH. Whereas having type 2 diabetes(OR _Adjusted : 0.89, 95 % CI: 0.81, 0.97), HbA1C levels(OR _Adjusted : 0.97, 95 % CI: 0.95, 0.99), and longer duration of diabetes(OR _Adjusted : 0.95, 95 % CI: 0.91, 0.99) were significantly associated with a decreased risk of PBH. Conclusion: Our study showed that gender, education level, insulin use, vitamin intake, type of surgical procedure, type 2 diabetes, preoperative HbA1C levels, and duration of diabetes were significantly associated with the prediction of PBH. Knowledge of predictors of PBH can help in postoperative care to prevent PBH.