Background: Post-bariatric hypoglycemia (PBH) is characterized by repeated episodes of severe hypoglycemia accompanied by neuroglycopenic signs and/or symptoms. Many individuals with PBH report chronic symptoms of cognitive impairment even when blood glucose values are not acutely low. In this study, cognitive function in individuals with PBH compared to age- and BMI-matched healthy controls (HC) was assessed using a quantitative visual paired comparison (VPC) task; a measurement validated to predict cognitive decline and Alzheimer’s disease.

Methods: 20 patients with confirmed PBH (plasma glucose <50 mg/dL with concomitant insulin ≥3 uU/mL, other causes having been ruled out) following Roux-en-Y gastric bypass surgery were compared to 54 age- (46±vs. 50±9 yrs, p=0.05) and BMI- (31±vs. 28±4 kg/m2, p=0.07) matched HCs. Patient-reported frequency of clinically-important hypoglycemic events, defined as fingerstick or plasma glucose <60 mg/dL, was collected by standardized questionnaire. The VPC task, which measures cognitive function by utilizing infrared eye tracking to assess the participant’s novelty preference when presented with a series of novel and familiar images, was conducted under standardized conditions when blood glucose was in the normal range in the clinical research unit.

Results: Compared to HCs, PBH patients scored 12% lower on the VPC task (0.65± 0.vs. 0.57 ±0.15, P= 0.005) . The mean VPC score in PBH patients was in the range that predicts a 22% risk of cognitive decline or Alzheimer’s disease over a 3-year period. Among PBH patients, patient-reported frequency of clinically important hypoglycemic events correlated significantly with VPC score (r=0.44, p=0.047) .

Conclusions: Patients with PBH exhibit cognitive impairment when compared to age- and BMI-matched HCs and the degree of impairment correlates with the frequency of clinically important hypoglycemic events.


T.Shamloo: None. C.M.Craig: Employee; Eiger BioPharmaceuticals, Stock/Shareholder; Eiger BioPharmaceuticals. M.Snyder: Stock/Shareholder; January, Inc. T.Mclaughlin: Board Member; January, Inc., Research Support; Merck & Co., Inc., Novo Nordisk, Stock/Shareholder; Eiger BioPharmaceuticals.


American Diabetes Association (1-19-ICTS-073) ; NIH 1U54DE02378901

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