Tirzepatide Improves Early Dumping Syndrome and Glucose Nadir in Postbariatric Hypoglycemia After Sleeve Gastrectomy

Early dumping syndrome (DS) and postbariatric hypoglycemia (PBH) are challenging conditions with limited treatment options. A 46-year-old woman with prediabetes, obesity, and sleeve gastrectomy presented with digestive symptoms suggestive of DS and postprandial hypoglycemia consistent with PBH. She started tirzepatide 2.5 mg weekly, which decreased postprandial blood glucose peaks, increased postprandial blood glucose nadirs, and improved overall time in range on continuous glucose monitoring (CGM). Her postprandial bloating and diarrhea resolved. To our knowledge, there have been no reported cases of DS or PBH treated with dual-incretin agonists. While glucagon-like peptide-1 (GLP-1) agonists have not been widely attempted in DS and have shown mixed benefit for PBH, combination GLP-1 and gastric inhibitory peptide agonism may represent a novel treatment both for PBH and DS, providing greater improvement in glycemic variation as well as better DS control than GLP-1 agonism alone.