Anakinra and empagliflozin reduce post-bariatric hypoglycemia by 71% in systematic review | Research

The takeaway

Systematic review of pharmacological therapies for post-bariatric hypoglycemia found anakinra and empagliflozin significantly reduced hypoglycemia risk (RR 0.29 each), with pasireotide, acarbose, dasiglucagon, and GLP-1 drugs also showing promise.

71% hypoglycemia reduction
Both anakinra (IL-1 receptor antagonist peptide) and empagliflozin significantly reduced post-bariatric hypoglycemia events in this systematic review

What the researchers found

Anakinra: RR 0.29 (95% CI 0.09-0.91). Empagliflozin: RR 0.29. Dasiglucagon: effective rescue. Pasireotide + acarbose: 100% prevention in single-arm studies. Liraglutide, verapamil, semaglutide: variable in case reports. 13 comparative + 5 single-arm + 15 case reports.

Why it matters

PBH causes dangerous hypoglycemia in post-bariatric patients and has no established treatment guidelines. This is the first systematic comparison of all pharmacological options, highlighting peptide-based therapies (anakinra, dasiglucagon, pasireotide) among the most promising.

How the study worked

Systematic review and mixed treatment comparison per PRISMA. MEDLINE, Cochrane, Google Scholar. 33 studies total. RR meta-analysis. GRADE assessment.

What this study cannot tell us

Very low evidence quality (GRADE). Small sample sizes. Heterogeneous PBH definitions. Most data from small RCTs or case reports. No long-term data.

How to read the evidence

Systematic review with very low GRADE evidence. Hypothesis-generating; larger trials urgently needed.

When this study was published

Published in 2025.

The bigger picture

As bariatric surgery becomes more common, PBH will increase. Multiple peptide-based therapies (anakinra/IL-1Ra, dasiglucagon, pasireotide) show promise, representing a new application area for peptide drugs.

Questions still open

Should anakinra become first-line for PBH?
Could GLP-1 drugs paradoxically worsen some PBH cases?
Which patients post-bariatric surgery should be prophylactically treated?

Common questions

What is post-bariatric hypoglycemia?

PBH occurs when blood sugar drops dangerously low after bariatric surgery, especially gastric bypass. It happens because the surgery changes gut hormone release, causing excessive insulin secretion after meals. It can cause dizziness, confusion, and even seizures.

How can post-bariatric hypoglycemia be treated?

This review found that anakinra (an anti-inflammatory injection) and empagliflozin (a diabetes pill) each reduced hypoglycemia episodes by 71%. Pasireotide (a somatostatin analogue) prevented all episodes in smaller studies. Dasiglucagon (a glucagon peptide) works as an emergency rescue. More research is needed to establish standard treatments.

Read the original research

Managing post-bariatric hypoglycemia: a systematic review of pharmacological therapies.

Diabetology & metabolic syndrome, 17(1), 404

View on PubMed ↗Publisher’s paper ↗

Citation

Sridharan, Kannan; Sivaramakrishnan, Gowri. (2025). Managing post-bariatric hypoglycemia: a systematic review of pharmacological therapies.. Diabetology & metabolic syndrome, 17(1), 404. https://doi.org/10.1186/s13098-025-01988-y