Continuous Glucose Monitoring in Patients With Postbariatric Hypoglycemia: Effect on Hypoglycemia and Quality of Life.

Context: Postbariatric hypoglycemia (PBH), complicating up to one-third of bariatric surgeries, is characterized by repeated episodes of severe hypoglycemia and hypoglycemia unawareness that threaten patient safety and impair quality of life.

Objective: We tested the hypothesis that use of a continuous glucose monitor (CGM) would reduce hypoglycemia and improve quality of life in patients with PBH.

Design: In a crossover design, 14 patients with diagnosed PBH were assigned in random order to sequential treatment with unblinded CGM or blinded CGM/no alarms for 10 days each. Glucose and quality of life measures were compared between the 2 periods.

Setting: Outpatient.

Outcomes: Hypoglycemia measured by fingerstick blood glucose in response to symptoms or CGM alarm and CGM glucose values; quality of life measures included dietary liberalization and hypoglycemia-related worries/behaviors captured by the Hypoglycemia Fear Survey-II.

Results: Baseline frequency of hypoglycemic events, disability, and hypoglycemia-related worries were high. Symptom-triggered hypoglycemic events confirmed by fingerstick glucose were reduced 6-fold (P = .008) and the glucose nadir measured by CGM was >8 mg/dL higher (P = .005) during unblinded use of CGM compared to the blinded comparison period. Hypoglycemia Fear Survey-II scores improved significantly in response to unblinded CGM use compared to the blinded control period (P = .026). The intake of carbohydrate-containing meals increased without increasing rate of postprandial hyper- or hypoglycemia.

Conclusion: Use of unblinded CGM in patients with PBH reduces frequency and severity of hypoglycemia and improves quality of life by decreasing hypoglycemia-related worries and enabling a less restrictive diet. CGM should be considered a first-line treatment for patients with PBH.