SAT-560 Glucagon Like Peptide 1 Receptor Agonists as a Potential Treatment of Post Bariatric Hypoglycemia

Abstract Disclosure: M. Riordan: None. A. Amaro: Novo Nordisk, Altimmune. Background: Post-bariatric hypoglycemia (PBH) is a complication of Roux-en-Y gastric bypass (RYGB), occurring months to years postoperatively. It is characterized by neuroglycopenic symptoms that can significantly impact quality of life. Management typically includes dietary modifications and pharmacotherapy with acarbose, octreotide, nicardipine, or diazoxide; however, effective treatment remains challenging. The pathophysiology is incompletely understood but likely involves altered hormonal and glycemic patterns. Although glucagon-like peptide 1 receptor agonists (GLP1-RAs) are incretin mimetics, they have been proposed as a potential off-label therapy for PBH due to their ability to slow gastric emptying and stabilize postprandial glycemia without worsening hypoglycemia. Objective: The aim of this study is to evaluate the impact of GLP1-RAs on glycemic control and hypoglycemia symptoms in patients with PBH treated at Penn Metabolic Medicine. Methods: A retrospective chart review was conducted on 29 patients diagnosed with PBH between March 2017 and November 2024. Patient demographics, surgical history, prior treatments, and glycemic outcomes were analyzed. Continuous glucose monitor (CGM) data from visits before and after GLP1-RA initiation were compared. Results: Of the 29 patients, 28 were female, with a mean age of 48.6 years (range: 34-71) and a mean BMI of 31.4 kg/m². Most (79.3%) had undergone RYGB, with a mean interval of 4.6 years from surgery to PBH diagnosis. Additionally, 15 (51.7%) had prior severe, level 3 hypoglycemia. All received dietary counseling, and 18 (62.1%) had been previously prescribed pharmacotherapy to treat PBH. Twenty-one initiated GLP1-RAs, with 81.0% reporting symptomatic improvement on follow-up. CGM data were available for 14 patients before and after treatment. Analysis of CGM data showed time in range increased from 86.9% to 91%, and time spent below range (<70 mg/dL) decreased (6.9% to 6.6%). Level 2 hypoglycemia (<54 mg/dL) declined from 0.84% to 0.44%. No level 3 hypoglycemia events were reported post-treatment. Weight data were available for 14 patients; 7 lacked records due to telemedicine visits conducted during the COVID19 pandemic. The average weight change was weight loss of 11.67 lbs (range: +7 to -25 lbs). Conclusion: GLP1-RAs may be an effective treatment for PBH, particularly in patients refractory to dietary changes or other medications. Further studies are needed to confirm long-term efficacy and safety. Presentation: Saturday, July 12, 2025