Awareness and management of post-bariatric hypoglycemia: an international survey of healthcare professionals

Abstract Postprandial hypoglycemia (PBH) is a recognized complication following bariatric surgery, but real-world data on its management by healthcare professionals (HCPs) is lacking. To address this, a 25-item multilingual questionnaire was developed and distributed online to HCPs treating patients after bariatric surgery. The survey assessed awareness, diagnostic criteria, and treatment strategies related to PBH, with 312 responses analyzed from 32 countries. Respondents had a mean age of 48.8 years; 54.5% were male, 46% worked in bariatric surgery, and 59% had over 10 years of experience. While awareness of PBH was high (> 73%), estimates of PBH prevalence varied considerably. The largest proportion of respondents estimated that 1–5% of their bariatric patients were affected (38.2%), followed by 6–10% (25.9%), with progressively fewer respondents selecting higher prevalence categories. There was no clear consensus on diagnostic thresholds, and management strategies differed significantly. Nutritional therapy was the most common first-line approach, and acarbose was the most frequently used medication (59%). However, preferences for second-line treatments varied. Notably, over half of the HCPs cited lack of reimbursement as a barrier to optimal care. Despite strong awareness, the management of PBH remains inconsistent, underlining the need for clearer guidelines and further research to standardize diagnostic and therapeutic approaches.