Post-bariatric Hypoglycemia Management: A Gulf Cooperation Council Consensus Statement

Post-bariatric hypoglycemia (PBH) is a late complication of metabolic and bariatric surgery that typically manifests over 1 year after the procedure. The clinical manifestation spans from mild hypoglycemia responsive to dietary modifications to severe hypoglycemia with neuroglycopenic symptoms. Despite its clinical significance and the growing body of evidence, the management of PBH remains heterogeneous, primarily due to its complex, multifactorial pathophysiology, the lack of standardized diagnostic criteria and Food and Drug Administration (FDA)-approved pharmacological treatments, and discrepancies in diagnostic and therapeutic approaches across available clinical guidelines. This consensus aims to establish a unified, evidence-based, and patient-centered management protocol for PBH. A panel of 16 experts, encompassing representatives from all Gulf Cooperation Council (GCC) countries and Europe, conducted an extensive review of the current literature to assemble the most recent evidence on PBH management. The panel then collaboratively developed a set of statements to standardize the diagnosis and treatment of PBH. Consensus was reached on all the statements using the Delphi method. Consensus was attained on 45 statements encompassing the entire PBH management continuum, including diagnosis, dietary management, patient education, and pharmacological treatment, with special considerations during pregnancy, long-term monitoring, and practical aspects of clinical management. Implementing these consensus statements into clinical practice will contribute to the standardization of PBH management. Furthermore, the statements highlight significant gaps in PBH management, including the lack of PBH-specific therapies and the scarcity of robust trials, which urgently require attention in future research and clinical development.