Medical Management of Endocrine Disorders after Bariatric Surgery

Endocrine complications after bariatric surgery include persistent hyperglycemia in patients with type 2 diabetes who experience initial success with weight loss. This complication occurs in those with a prolonged duration of diabetes (> 8 years) and is related to poor residual pancreatic beta-cell function. Often, weight regain is associated with recurrent diabetes, and strategies that target both weight loss and glycemic control are required. New diabetes agents, such as the SGLT2 inhibitor drug class, offer advantages to diabetes treatment after bariatric surgery. On the other end of the glycemic spectrum, hyperinsulinemic hypoglycemia occurs in patients with and without diabetes prior to surgery and often presents with little or no symptoms (i.e., neuroglycopenia). Treatment strategies involve careful monitoring of blood glucose levels and the use of low-glycemic/high-fiber diets as well as drugs that lower glucose absorption and insulin secretion. Glycemic management after bariatric surgery requires close observation.