What does this research mean for the field?

Patients with post-bariatric hypoglycemia exhibit significantly faster gastric emptying than asymptomatic surgical controls, and while GLP-1 receptor agonists slow this emptying, they do not reduce hypoglycemia. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

What question did this study set out to answer?

To determine if GLP-1 receptor agonists can slow gastric emptying and reduce hypoglycemia in patients with post-bariatric hypoglycemia.

June 7, 2026

1363-P: Glucagon-Like Peptide 1 Receptor Agonists Slow Gastric Emptying but Do Not Prevent Hypoglycemia in Patients with Post-Bariatric Hypoglycemia

Key Points

To determine if GLP-1 receptor agonists can slow gastric emptying and reduce hypoglycemia in patients with post-bariatric hypoglycemia.
Compared gastric emptying in 17 PBH patients to 10 surgical controls and 12 non-surgical controls using solid meal scintigraphy.
Conducted a 12-week crossover trial with 16 PBH patients to assess the effects of GLP-1a on gastric emptying and hypoglycemia during meal tests.
PBH patients had significantly faster gastric emptying with 1-hr residual volume of 5.6% compared to 17.9% in surgical controls (p=0.031) and 45.6% in non-surgical controls (p<0.001).
GLP-1a treatment increased the 1-hr residual volume to 22.4% in PBH patients (p=0.038).
Postprandial glucose peaked at 192 mg/dL with GLP-1a versus 169 mg/dL without (p=0.009), but no change in hypoglycemia was observed.

Abstract

Introduction and Objective: Roux-en-Y gastric bypass (RYGB) induces long term remission of type 2 diabetes in 80% of patients, but approximately 30% develop post-bariatric hypoglycemia (PBH) characterized by frequent neuroglycopenic episodes. Prior work suggests that altered nutrient transit after surgery leads to exaggerated incretin and insulin responses, but factors distinguishing the subset of patients who develop PBH are unclear. We hypothesized that faster gastric pouch emptying increases PBH risk and that slowing gastric emptying with GLP-1a treatment would improve hypoglycemia. Methods: Patients with diagnosed PBH (n=17) were compared to 10 RYGB without PBH (surgical controls) and 12 non-surgical controls, concerning gastric emptying measured by solid meal scintigraphy. A subset of 16 PBH patients (11 RYGB and 5 sleeve gastrectomy) did a 12-wk crossover study to determine if GLP-1a treatment slowed gastric emptying and reduced hypoglycemia. This cohort underwent solid meal scintigraphy (n = 6) and/or glucose testing (n = 12) during standardized mixed meal tolerance test on and off GLP-1a treatment. Results: Gastric emptying was markedly accelerated in PBH patients compared to both non-surgical and surgical controls. 1-hr residual volume was significantly lower in PBH patients vs surgical controls (5.6% vs 17.9% p=0.031) and nonsurgical controls (45.6%, p0.001). GLP-1a treatment significantly slowed gastric emptying in PBH patients, increasing 1-hr residual volume to 22.4% (p=0.038). GLP-1a therapy increased postprandial glucose peak (192 vs 169 mg/dL p=0.009) but did not alter glucose nadir. Conclusion: Patients with PBH exhibit significantly faster gastric emptying than asymptomatic RYGB controls. While GLP-1a significantly slows emptying in RYGB and SG patients, on average there is no reduction in hypoglycemia during a standardized meal test. GLP-1a may offer clinical benefits via other mechanisms such as increased adherence to low-carbohydrate diet, but this remains to be demonstrated. Disclosure N. Turk: None. J. Yang: None. E. Yandle: None. D. Azagury: Advisory Panel; Current; Endolumik, Form health, Moon Surgical, GI windows. M. Esquivel: Consultant; Current; Intuitive Surgical. T. McLaughlin: Research Support; Ended; Lilly. Advisory Panel; Ended; Regeneron Pharmaceuticals Inc. Research Support; Current; Recordati S.p.A. Stock/Shareholder; Current; January, Inc. Research Support; Current; WW International, Inc. Consultant; Ended; Eiger BioPharmaceuticals. Advisory Panel; Current; Amylyx. Consultant; Current; Oura. Research Support; Current; Dexcom, Inc. Funding American Diabetes Association (1-19-ICTS-073)

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