Tirzepatide for treatment of postbariatric hypoglycemia after Roux-en-Y gastric bypass: a report of 3 cases.

Postbariatric hypoglycemia (PBH) represents a challenging complication of bariatric surgery. This case series describes 3 patients with PBH following Roux-en-Y gastric bypass who were treated with tirzepatide, a glucagon-like peptide-1 (GLP-1) and glucose-dependent insulinotropic polypeptide (GIP) receptor agonist (RA). All patients presented with symptomatic hypoglycemia characterized by episodes of diaphoresis, visual disturbances, confusion, and documented low blood glucose levels occurring postprandially. Conventional management strategies, including dietary modifications, acarbose, and other pharmacotherapies, were either partially effective or limited by side effects. Initiation of tirzepatide led to increased time in range, reduced number and severity of hypoglycemic episodes, and decreased glucose variability. This report suggests that GLP-1 and GIP RA can be a promising adjunct in managing PBH; however, further studies to confirm their efficacy and establish optimal dosing strategies are needed.