SAT-562 Prevalence of Postbariatric Hypoglycemia in the United States

Abstract Disclosure: C.M. Craig: Amylyx, Aardvark. T.L. McLaughlin: Regeneron Pharmaceuticals, Amylyx, January AI, Recordati. Significance: Post-bariatric hypoglycemia (PBH) is a complication of bariatric surgery in which postprandial hypoglycemia can be severe, frequent, and debilitating. It does not remit over time and there are no approved therapies. The incidence reported in the published literature varies from 0.1% to 75% of all bariatric procedures, largely due to differences in methodologies and definitions used to identify incident cases. To accurately define the burden of PBH, the incidence and prevalence must be ascertained, with accurate definitions of incident cases used. We performed a critical review of published literature with the following goals: 1) Outline differences between methodologies and definitions used to determine incidence of PBH; 2) Suggest optimal parameters to use in defining incident cases; 3) Provide incidence estimates for “Any PBH” and “Medically-Important PBH” based on published studies using best methods; 4) Estimate current U.S. prevalence based on surgical census data and disease-state modeling. Methodologic Assessment: Studies estimating PBH incidence include retrospective registry and hospital studies interrogating registry and electronic medical records, observational patient-reported outcomes studies, prospective hypoglycemia provocation studies, and prospective continuous glucose monitor (CGM) studies. Inconsistencies exist across studies in diagnostic codes used to define incident cases, glycemic thresholds used to define events, and requirement for hypoglycemia symptoms. Underestimation may result from hypoglycemia unawareness, treatment before glucose is checked, not seeking medical attention, misdiagnosis, difficulty obtaining glucose at time of event, short duration of sampling after provocation, and survey response bias. Overestimation may result from use of high glycemic thresholds (e.g., <60mg/dL), use of oral glucose tolerance tests for provocation, and inaccuracies in CGM readings. Incidence estimates: Based on Level A studies, categorized by surgery type and severity: Any PBH (> 3 symptoms hypoglycemia, neuroglycopenia, need for assistance, or glucose ≤54 mg/dL): RYGB 32%; VSG 11.8%Medically-Important PBH (visit to inpatient or outpatient facility): RYGB 11.8%; VSG 4.2% Prevalence estimates: Based on surgeries performed 1993-2023, incidence estimates, and life expectancy estimates (Center for Vital Statistics):RYGB: Any PBH: 323,658; Medically important PBH: 119,350VSG: Any PBH: 128,213; Medically important PBH: 46,719Total: Any PBH: 451,871; Medically important PBH: 166,069 Clinical Implications: With over 450,000 affected individuals in the U.S., and more than one-third requiring medical attention, PBH represents a significant burden. These findings underscore the need for standardized definitions and diagnostic criteria and development of safe and effective therapies. Presentation: Saturday, July 12, 2025