Randomized, Double-Blind, Placebo-Controlled Crossover Trial of Once Daily Empagliflozin 25 mg for the Treatment of Postprandial Hypoglycemia After Roux-en-Y Gastric Bypass

Aims: To investigate the effect of empagliflozin on glucose dynamics in individuals suffering from postbariatric hypoglycemia (PBH) after Roux-en-Y gastric bypass (RYGB).Methods: Twenty-two adults with PBH after RYGB were randomized to empagliflozin 25 mg or placebo once daily over 20 days in a randomized, double-blind, placebo-controlled, crossover trial. The primary efficacy outcome was the amplitude of plasma glucose excursion (peak to nadir) during a mixed-meal tolerance test (MMTT). Outcomes of the outpatient period were assessed using continuous glucose monitoring (CGM) and an event-tracking app.Results: The amplitude of glucose excursion during the MMTT was 8.1 +/- 2.4 mmol/L with empagliflozin versus 8.1 +/- 2.6 mmol/L with placebo (mean +/- standard deviation, P = 0.807). CGM-based mean amplitude of glucose excursion during the 20-day period was lower with empagliflozin than placebo (4.8 +/- 1.3 vs. 5.2 +/- 1.6. P = 0.028). Empagliflozin reduced the time spent with CGM values >10.0 mmol/L (3.8 +/- 3.5% vs. 4.7 +/- 3.8%, P = 0.009), but not the time spent with CGM values <3.0 mmol/L (1.7 +/- 1.6% vs. 1.5 +/- 1.5%, P = 0.457). No significant difference was observed in the quantity and quality of recorded symptoms. Eleven adverse events occurred with empagliflozin (three drug-related) and six with placebo.Conclusions: Empagliflozin 25 mg reduces glucose excursions but not hypoglycemia in individuals with PBH.