Prospective Observational Study Treating PBH In Daily Life

Post bariatric hypoglycemia (PBH) is a frequently observed complication after bariatric surgery. The first treatment is a diet low in carbohydrates with frequent meals. a substantila number of patients will be well controled with diet alone, however there a more and more patients needing medical treatment. The medical treatment options for PBH are acarbose, diazoxide, somatostatin analogues and GLp-1 agonists. The literature on the results of these medications is limited to case reports and small cohort studies. There are currently no studies on treatment algorithms in larger cohorts. Internists involved with PBH in the Netherlands have agreed upon a treatment algorithm using stepwise acarbose, diazoxide, octreotide and finally liraglutide. The aim of this study is to prospectively document the percentage of success with the different medications using this algorithm. Patients can participate when they still have hypoglycemic complaints interfering with daily activities despite adequate dietary advice by a registered dietician with experience in post bariatric surgery patients. Data will be documented on patients charcteristics, surgery type, time to first hypoglycemic event, too of hypoglycemic documentation, frequency of hypos, quality of life (RAND36) and dumping severity (DSS).

As there are no data on the percentage of success with the individual medications in the literature available a rough estimate based on personal experience is made.
50% will do well on acarbose
10% of the failures with acarbose will do well on diazoxide ( 0.1 x 0.5= 5%)
60% of failures on both will respond well to octreotide ( 0.6 x 45 = 27%)
leaving 100-50-5-27 = 18 % candidates for GLP-1 agonists
Starting with 100 patients information will be aquired with :
Acarbose : 100 pts
Diazoxide : 50 pts
Octreotide : 45 pts
GLP-1 analog : 18 pts

evaluation with each medication after 3 months

none