Clinical Efficacy Evaluation of a Continuous Glucose Monitoring-Guided Forecasting Algorithm to Mitigate Postbariatric Hypoglycemia: A Randomized Controlled Trial

Postbariatric hypoglycemia (PBH) after Roux-en-Y gastric bypass predisposes to health risks and impaired quality of life. Given limited therapeutic options, we evaluated the efficacy of a continuous glucose monitoring (CGM)-guided forecasting algorithm to reduce PBH. In this randomized trial, 59 participants underwent a standardized meal test and were assigned to receive 5 g of glucose either upon the algorithm's predictive alert (intervention, n = 32) or when plasma glucose declined below 3.0 mmol/L (control, n = 27). Hypoglycemia incidence (<3.0 mmol/L) was 31% in the intervention group and 44% in the control group (P = 0.30). Nadir glucose and time spent below 3.9 and 3.0 mmol/L did not differ significantly between groups. Extrapolation based on previously published glucose dose-response data suggests that increasing the preventive glucose dose to 10 g could reduce hypoglycemia incidence to 9%. While a 5 g preventive dose was insufficient, these simulations indicate that CGM-guided hypoglycemia forecasting warrants evaluation as an approach for reducing postprandial hypoglycemia in individuals with PBH.