Outpatient Treatment of Postbariatric Hypoglycemia With Canagliflozin.

Background/Objective: The goal of this study was to examine canagliflozin's efficacy in treating postbariatric hypoglycemia (PBH) in a real-world setting. We hypothesized that canagliflozin, a sodium-glucose cotransporter 1/2 inhibitor, would reduce postprandial hyperglycemia and hypoglycemia. Case Report: Retrospective analysis was performed on continuous glucose monitor data of 4 patients (3 females and 1 male) with PBH from Roux-en-Y gastric bypass who took canagliflozin 300 mg daily. The number of postprandial hyperglycemic (180-250 mg/dL and >250 mg/dL) and hypoglycemic (54-69 mg/dL and <54 mg/dL) episodes in a 4-week period before canagliflozin was started and a 4-week period on canagliflozin was compared using paired t-test statistics. Patients' subjective reports of PBH symptoms prior to and on canagliflozin were obtained from review of chart notes. Discussion: Although canagliflozin was well tolerated with 1 reported urinary tract infection, canagliflozin did not significantly reduce hypoglycemic episodes or attenuate postprandial hyperglycemic excursions depicted on continuous glucose monitor. Subjectively, most patients did not report improvement in PBH symptoms. This led to discontinuation of canagliflozin in 3 of the 4 cases. Conclusion: Canagliflozin was not found to reduce postprandial hyperglycemia or hypoglycemia in PBH. Because sodium-glucose cotransporter 1 inhibition is brief and transient, it is likely that the postulated beneficial effects of canagliflozin may depend on timing of medication administration.