SUN-619 Outpatient Treatment of Post-Bariatric Hypoglycemia with Canagliflozin

Abstract Disclosure: E. Looi: None. H.M. Lawler: None. Objective: Post-bariatric hypoglycemia (PBH) is a complication that develops after bariatric surgery and treatment options are limited. After Roux-en-Y gastric bypass (RYGB), there is increased expression of intestinal sodium-glucose cotransporters (SGLT-1), which may worsen postprandial hyperglycemia and stimulate exaggerated insulin secretion. At doses ≥ 200mg, canagliflozin, an SGLT-2 inhibitor, also inhibits SGLT-1. The goal of this study was to examine canagliflozin’s efficacy in treating PBH in a real-world setting. We hypothesized canagliflozin, an SGLT-1/2 inhibitor, would lead to reduced postprandial hyperglycemia and hypoglycemia. Methods: Retrospective analysis was performed on continuous glucose monitor (CGM) data of four patients, 3 female and 1 male, with PBH after RYGB (mean PBH onset 2.3 years, mean pre-op BMI 45.3 kg/m2) who took canagliflozin 300 mg daily for at least one month (mean duration of use 2.3 months). Post-prandial was defined as a rise in blood glucose (BG) > 20 mg/dL from baseline BG and the post-prandial period was defined as the 4-hour period after the start of the BG rise. The number of CGM postprandial hyperglycemic episodes (> 180-250 mg/dL and > 250mg/dL) and CGM postprandial level 1 (54-69mg/dL) and level 2 (< 54mg/dL) hypoglycemic events in a 4-week period before canagliflozin was started and a 4-week period on canagliflozin 300mg daily were compared using paired t-test statistics. In addition, chart notes were reviewed to obtain patients’ subjective reporting of PBH symptoms both prior to canagliflozin and on canagliflozin. Results: Canagliflozin did not reduce hypoglycemic episodes or attenuate postprandial hyperglycemic excursions. Compared to before canagliflozin, there was no significant reduction in postprandial hyperglycemic events with BG > 180 mg/dL (p = 0.48), hyperglycemic events with BG > 250 mg/dL (p = 0.41), level 1 hypoglycemic events (p = 0.27), or level 2 hypoglycemic events (p = 0.14). Subjectively, one patient reported a noticeable decrease in hyperglycemia but not hypoglycemia while another reported a slight decrease in hypoglycemia but not hyperglycemia. This led to discontinuation of the medication in 3 of the 4 cases. Canagliflozin was well tolerated other than a urinary tract infection in one patient. Conclusions: Canagliflozin was not found to reduce postprandial hyperglycemia or postprandial hypoglycemia in a real-world setting using canagliflozin for treatment of PBH. Since SGLT-1 inhibition is brief and transient, it is likely the postulated beneficial effects of canagliflozin may be dependent on timing of medication administration in relation to caloric consumption. Further clinical trials are needed to better understand and characterize the use of canagliflozin in patients with PBH. Presentation: Sunday, July 13, 2025