Adverse Health Outcomes Associated with Hypoglycemia Following Bariatric Surgery

<b><i>Introduction:</i></b> Hypoglycemia is prevalent among patients postbariatric surgery, but its clinical implications remain unclear. The purpose of this study was to examine the longitudinal associations of hypoglycemia (<i>i.e.,</i> occurrence in the past 3 months, frequency in the past 7 days, number of severe episodes in the past 3 months, and symptoms) with depressive symptoms, quality of life (QoL), work productivity, and weight loss over an 84-month follow-up period after bariatric surgery. <b><i>Methods:</i></b> This secondary analysis used data from the Longitudinal Assessment of Bariatric Surgery-2 study. Hypoglycemia, depressive symptoms, QoL, and work productivity were self-reported. Weight was primarily based on objective measures. Linear mixed modeling with time-lagged techniques was used for analysis, adjusting for potential covariates such as age and gender. <b><i>Results:</i></b> Across the 84-month follow-up, 20%-30% of participants (<i>N</i> = 552) reported experiencing hypoglycemia in the past 3 months. Hypoglycemia occurrence was positively associated with depressive symptoms [β = 2.4; 95% confidence interval (CI): 1.7, 3.0] and negatively associated with physical (β = -4.2; 95% CI: -5.1, -3.3) and mental QoL (β = -3.4; 95% CI: -4.4, -2.4). These associations became stronger with increased frequency of hypoglycemia, a higher number of severe episodes, and the presence of symptoms. Additionally, hypoglycemia occurrence was associated with several domains of work productivity, including presenteeism (β = 5.8; 95% CI: 3.4, 8.2), work productivity loss (β = 5.6; 95% CI: 2.6, 8.6), and activity impairment (β = 8.8; 95% CI: 6.0, 11.6), with the strength of these associations increasing with greater hypoglycemic frequency. <b><i>Conclusions:</i></b> This study highlights the critical role of hypoglycemia in patients' physical and psychosocial well-being postbariatric surgery. Future studies employing more rigorous measures of hypoglycemia and expanded outcomes (<i>e.g.</i> cognitive function) are needed to fully understand its clinical relevance.