253-OR: Effect of Continuous Glucose Monitoring on Hypoglycemia, Diet Liberalization, and Quality of Life in Post-bariatric Hypoglycemia

Post-bariatric hypoglycemia (PBH), affecting up to 39% of patients with Roux-en-Y gastric bypass (RYGB), is associated with episodes of disabling hypoglycemia, chronic diet restriction and reduced quality of life (QoL). We evaluated the effects of unblinded vs blinded CGM on hypoglycemia, dietary liberalization, and QoL. 15 RYGB patients with confirmed PBH wore in random order, a Dexcom G6 Pro for 10 days blinded and 10 days unblinded with alarm set to 65 mg/dL. The Hypoglycemia Fear Survey II (HFS-II) was administered after each phase to assess hypoglycemia-based worries and behaviors. The number of hypoglycemia events <70, 54, and 40 mg/dL and proportion of time below each threshold was assessed (diurnal and nocturnal) and adjusted for meal intake. The number of diurnal hypoglycemic events <40 and <54 mg/dL were reduced by 66% and 25% respectively, and proportion of time was reduced by 71% and 50% respectively during unblinded vs blinded CGM use, though neither measure reached statistical significance. Diet liberalization was significantly greater during unblinded CGM use (54 vs 45 glucose spikes/10-day period, p=0.012). HFS-II showed improvement in 16/19 worry measures, reaching statistical significance in six. CGM use in patients with PBH enabled diet liberalization, reduced hypoglycemia-based worries, and reduced diurnal hypoglycemia, indicating improved QoL.