SUN-570 - Characterizing the Burden of Post-Bariatric Hypoglycemia in the United States

Background
Metabolic and bariatric surgery (MBS) is highly effective for achieving sustained weight loss and improving obesity-related comorbidities. However, some individuals develop post-bariatric hypoglycemia (PBH), a chronic metabolic condition characterized by recurrent hyperinsulinemic hypoglycemia events. PBH is driven by altered hormonal and glycemic patterns, including an exaggerated glucagon-like peptide-1 (GLP-1) response to altered nutrient transit. Hypoglycemic events can cause neuroglycopenic symptoms, impaired cognition, loss of consciousness, and seizures, leading to emergency room visits, hospitalizations, disability, accidents, and other medical and safety risks. Importantly, the impact of PBH extends beyond the acute hypoglycemic phase: recurrent events contribute to long-term psychosocial burden, stigma, and reduced quality of life, as well as potential risks for hypoglycemia unawareness, cardiovascular events, cognitive decline, and mortality as suggested by diabetes literature. Despite these serious consequences, PBH remains underrecognized, with limited data and no FDA-approved treatments.

Objective
To characterize the overall burden of PBH in the U.S., including healthcare resource utilization, economic impact, and humanistic outcomes, and examine how burden varies by severity while contextualizing findings against MBS benefits.

Methods
A pragmatic literature search was conducted to identify evidence of PBH-related impacts on healthcare resource use, costs, and quality of life. The data informed an adapted economic model based on prior hypoglycemia frameworks to estimate the multifaceted burden of PBH. Given the scarcity of PBH-specific data, assumptions were guided by published evidence on hypoglycemia event burden in diabetes, with adjustments to reflect PBH’s distinct pathophysiology and clinical course.

Results & Conclusions
Preliminary findings identified approximately 30 publications addressing aspects of PBH burden. Early economic context was drawn from related literature, where hypoglycemic episodes requiring assistance from a health care practitioner in the context of diabetes amounted to approximately $1,160 in direct healthcare costs per episode. Overall, initial insights from the current evaluation indicate that PBH imposes an economic burden, driven by increased healthcare utilization and indirect costs related to productivity loss. Modeling suggests that these impacts are clinically meaningful and can compound the psychosocial challenges. Emerging evidence suggests that at least 1 in 12 individuals post-MBS experience PBH requiring medical intervention, highlighting its clinical significance and population-level burden. Understanding this impact is critical for informing policy, guiding resource allocation, and supporting strategies to improve outcomes.

*Unless otherwise noted, all abstracts presented at ENDO must not be released to the press or the public until the date and time of presentation. For oral presentations, the abstracts are embargoed until the session begins. The Endocrine Society reserves the right to lift the embargo on specific abstracts that are selected for promotion prior to or during ENDO.*