Post-Bariatric Hypoglycemia - Market Insight, Epidemiology, and Market Forecast - 2034

Key Highlights

• In 2023, the United States accounted for approximately 90% of the total Post-Bariatric hypoglycemia market size within the seven major markets.
• Post-Bariatric hypoglycemia is the development of hypoglycemia (low blood sugar) following bariatric surgery, such as gastric bypass or sleeve gastrectomy. It typically occurs within a few years after surgery.
• Several risk factors contribute to Post-Bariatric hypoglycemia, including rapid weight loss, altered gastrointestinal anatomy, increased insulin sensitivity, hyperinsulinemia, and reactive hypoglycemia.
• In 2023, there were approximately 100,000 cases of Post-Bariatric hypoglycemia (PBH) Cases in the 7MM. Among the 7MM, the United States accounted for the highest number of cases, which was followed by France.
• Several risk factors contribute to Post-Bariatric hypoglycemia, including rapid weight loss, altered gastrointestinal anatomy, increased insulin sensitivity, hyperinsulinemia, and reactive hypoglycemia.
• Bariatric surgery has proven to be the most effective treatment for severe obesity, leading to significant improvements in body mass index and obesity-related co-morbidities. With increasing bariatric surgery procedures performed per year in the United States, postoperative prevalence of hypoglycemia symptoms in bariatric surgery patients is also increasing.
• The pathophysiology of Post-Bariatric hypoglycemia is complex and involves several inter-related mechanisms. It is believed to result from alterations in the normal hormonal and metabolic response to food intake following bariatric surgery.
• Diagnosis of Post-Bariatric hypoglycemia involves a combination of clinical evaluation, medical history review, blood glucose monitoring, and ruling out other potential causes of hypoglycemia. Additional tests such as mixed meal tolerance tests, continuous glucose monitoring, and pancreatic imaging may be utilized to aid in diagnosis.
• The management of Post-Bariatric hypoglycemia involves dietary modifications, such as consuming small and frequent meals, avoiding high-glycemic index foods, and restricting simple sugars. Post-Bariatric hypoglycemia Medications, including acarbose, diazoxide, or glucagon-like peptide-1 (GLP-1) receptor agonists, may be prescribed to help control blood sugar levels. In severe cases, surgical interventions, such as partial or complete reversal of the bariatric surgery, may be considered.
• There are currently no therapeutics approved by the FDA for the treatment of Post-Bariatric hypoglycemia. However, few therapies are being investigated for the treatment of Post-Bariatric hypoglycemia.
• Some key Post-Bariatric hypoglycemia companies involved in the development are Vogenx (mizagliflozin) and Eiger BioPharmaceuticals (avexitide).
• In April 2024, Vogenx announced that it has completed dosing of the last patient in its Phase II clinical study VGX-001-012 evaluating mizagliflozin in patients diagnosed with post-bariatric hypoglycemia.

Post-Bariatric hypoglycemia Market Report Summary

• The Post-Bariatric hypoglycemia market report offers extensive knowledge regarding the epidemiology segments and predictions, presenting a deep understanding of the potential future growth in diagnosis rates, disease progression, and treatment guidelines. It provides comprehensive insights into these aspects, enabling a thorough assessment of the subject matter.
• Additionally, an all-inclusive account of the current management techniques and emerging therapies and the elaborative profiles of mid-stage (Phase II) and prominent therapies that would impact the current treatment landscape and result in an overall market shift has been provided in the report.
• The Post-Bariatric hypoglycemia market report also encompasses a comprehensive analysis of the disease, providing an in-depth examination of its historical and projected Post-Bariatric hypoglycemia market size (2020-2034). It also includes the market share of therapies, detailed assumptions, and the underlying rationale for our methodology. The Post-Bariatric hypoglycemia market report also includes drug outreach coverage in the 7MM region.
• The Post-Bariatric hypoglycemia market report includes qualitative insights that provide an edge while developing business strategies, by understanding trends, through SWOT analysis and expert insights/KOL views, including experts from various hospitals and prominent universities, patient journey, and treatment preferences that help shape and drive the 7MM Post-Bariatric hypoglycemia market.

The table given below further depicts the key segments provided in the report:

Post-Bariatric hypoglycemia Treatment Market

Post-Bariatric hypoglycemia Overview

Post-Bariatric hypoglycemia is an increasingly recognized complication of bariatric surgery, occurring after roux-en-Y gastric bypass (RYGB) and vertical sleeve gastrectomy (SG). Postbariatric surgery hypoglycemia, also known as reactive hypoglycemia and late dumping syndrome, is a metabolic complication in which a spike in glucose levels after eating a meal stimulates a high insulin secretion, leading to low blood sugar.

Post-Bariatric hypoglycemia Diagnosis

Diagnosis of Post-Bariatric hypoglycemia involves a combination of clinical evaluation, medical history review, blood glucose monitoring, and ruling out other potential causes of hypoglycemia. Additional tests such as mixed meal tolerance tests, continuous glucose monitoring, and pancreatic imaging may be utilized to aid in diagnosis.

Post-Bariatric hypoglycemia Treatment

Acarbose has been used as first-line treatment, although adverse gastrointestinal symptoms limit this option. Diazoxide and octreotide have been used with mixed results, but side effects and patient nonadherence limit their utility. Interestingly, exogenous GLP-1 receptor agonists have also demonstrated improvement in PBH, possibly through downregulation of insulin secretion from β-cells and increased secretion of glucagon from α-cells during conditions of hypoglycemia. Historically, surgical treatments were recommended more commonly, gastrostomy tube placement, reversal of gastric bypass anatomy, and distal pancreatectomy. It is worth using CCBs, nifedipine, or verapamil to bridge the treatment gap between nutrition and surgical therapy.

Post-Bariatric hypoglycemia Epidemiology

The Post-Bariatric hypoglycemia epidemiology chapter in the report provides historical as well as forecasted epidemiology segmented by Type-specific Bariatric Surgery Cases, Total Post-Bariatric hypoglycemia Cases, Post-Bariatric hypoglycemia Cases in types of Bariatric Surgeries, Severity-specific Post-Bariatric hypoglycemia Cases, and Total Treated cases of Post-Bariatric hypoglycemia in the United States, EU4 (Germany, France, Italy, Spain) and the United Kingdom, and Japan from 2020 to 2034.

• In 2023, the total Post-Bariatric hypoglycemia cases in the 7MM were estimated to be approximately 110,000 cases which, As per the estimation, will increase by 2034.
• In 2023, the US accounted for the highest cases of Post-Bariatric hypoglycemia with approximately 80% cases.
• As per analysis, in 2023, there were higher cases of Post-Bariatric hypoglycemia in sleeve gastrectomy cases, which was followed by Roux-en-Y gastric bypass cases, and cases in others in the US.
• As per severity of Post-Bariatric hypoglycemia, there were more than 90% cases in the mild to moderate category in 2023, in the United States.
• There were nearly 50,000 treated cases of Post-Bariatric hypoglycemia in 2023 in the United States.

Post-Bariatric hypoglycemia Market

Various key players are leading the treatment landscape of Post-Bariatric hypoglycemia (PBH), such as Vogenx, Eiger BioPharmaceuticals, and others. The details of the country-wise and therapy-wise market size have been provided below.

• In 2023, the Post-Bariatric hypoglycemia market size in the 7MM was nearly 200 USD million and it is expected to increase by 2034, driven by an increase in the cases of Post-Bariatric hypoglycemia and the launch of new therapies.
• Among the 7MM, the United States accounted for the highest Post-Bariatric hypoglycemia market size, followed by France and Italy, in 2023.
• Among the emerging therapies, Eiger BioPharmaceuticals’ AVEXITIDE is expected to garner the highest Post-Bariatric hypoglycemia market size during the forecast period (2024-2034).

Post-Bariatric hypoglycemia Drug Chapters

The section dedicated to drugs in the Post-Bariatric hypoglycemia market report provides an in-depth evaluation of mid-stage pipeline drugs (Phase II) related to Post-Bariatric hypoglycemia.

The drug chapters section provides valuable information on various aspects related to clinical trials of Post-Bariatric hypoglycemia, such as the pharmacological mechanisms of the drugs involved, designations, approval status, patent information, and a comprehensive analysis of the pros and cons associated with each drug. Furthermore, it presents the most recent news updates and press releases on drugs targeting Post-Bariatric hypoglycemia.

Post-Bariatric hypoglycemia Emerging Therapies

Mizagliflozin: Vogenx

Mizagliflozin follows an oral route of administration and minimally absorb the inhibitor of Sodium-glucose transporter 1 (SGLT1). Post-Bariatric hypoglycemia patients have elevated SGLT1 levels in the gut. This elevated blood glucose stimulates uncontrolled insulin secretion in Post-Bariatric hypoglycemia patients. In February 2024, Vogenx announced completion of patient enrollment of a mid-Phase II clinical dose ranging study (VGX-001-012) evaluating mizagliflozin in patients diagnosed with post-bariatric hypoglycemia.

AVEXITIDE (exendin 9-39): Eiger BioPharmaceuticals

AVEXITIDE (exendin 9-39) is a 31-amino acid peptide that selectively targets and blocks GLP-1 receptors, reducing dysregulated insulin secretion by the pancreas and reducing fasting and postprandial hypoglycemia. In June 2023, the company announced that the US FDA has granted breakthrough therapy designation to AVEXITIDE for the treatment of Post-Bariatric hypoglycemia.

Note: Detailed assessment will be provided in the final report of Post-Bariatric hypoglycemia…

Post-Bariatric hypoglycemia Market Outlook

Most of the therapies are based on case series or reports and extrapolated from their use in other conditions that cause hypoglycemia. Acarbose has been used as first-line treatment, although adverse gastrointestinal symptoms limit this option. Diazoxide and octreotide have been used with mixed results, but side effects and patient nonadherence limit their utility. Interestingly, exogenous GLP-1 receptor agonists have also demonstrated improvement in PBH, possibly through down regulation of insulin secretion from β-cells and increased secretion of glucagon from α-cells during conditions of hypoglycemia.

Several drugs are being investigated to treat Post-Bariatric hypoglycemia, including mizagliflozin and exendin 9-39. Both drugs have demonstrated significant improvements in PBH patients with well-tolerated safety profiles.

As no approved therapies are available in the Post-Bariatric hypoglycemia market, there is a huge opportunity for pharmaceutical firms to develop targeted and effective therapies for treating Post-Bariatric hypoglycemia.

Post-Bariatric hypoglycemia KOL Views

To stay abreast of the latest trends in the Post-Bariatric hypoglycemia market, we conduct primary research by seeking the opinions of Key Opinion Leaders (KOLs) and Subject Matter Experts (SMEs) who work in the relevant field. This helps us fill any gaps in data and validate our secondary research.

We have reached out to industry experts to gather insights on various aspects of Post-Bariatric hypoglycemia, including the evolving treatment landscape, patients’ reliance on conventional therapies, their acceptance of therapy switching, drug uptake, and challenges related to accessibility. The experts we contacted included medical/scientific writers, professors, and researchers from prestigious universities in the US, Europe, the UK, and Japan.

Our team of analysts, connected with more than 10 KOLs across the 7MM. We contacted institutions such as the King’s College London, University of Valencia, Arden University, Stanford University, etc., among others. By obtaining the opinions of these experts, we gained a better understanding of the current and emerging treatment patterns in the Post-Bariatric hypoglycemia market, which will assist our clients in analyzing the overall epidemiology and market scenario.

The opinion of experts from various regions has been provided below:

Post-Bariatric hypoglycemia Qualitative Analysis

We perform Qualitative and Market Intelligence analysis using various approaches, such as SWOT analysis and Conjoint Analysis. In the SWOT analysis, strengths, weaknesses, opportunities, and threats in terms of disease diagnosis, patient awareness, patient burden, competitive landscape, cost-effectiveness, and geographical accessibility of therapies are provided. These pointers are based on the Analyst’s discretion and assessment of the patient burden, cost analysis, and existing and evolving treatment landscape.

Conjoint Analysis analyzes multiple approved and emerging Post-Bariatric hypoglycemia therapies based on relevant attributes such as safety, efficacy, frequency of administration, designation, route of administration, and order of entry. Scoring is given based on these parameters to analyze the effectiveness of therapy.

In efficacy, the trial’s primary and secondary outcome measures are evaluated; for instance, in trials for Post-Bariatric hypoglycemia, one of the most important primary endpoints was change from baseline mean glucose nadir. Based on these, the overall efficacy is evaluated.

Further, the therapies’ safety is evaluated wherein the acceptability, tolerability, and adverse events are majorly observed, and it sets a clear understanding of the side effects posed by the drug in the trials. In addition, the scoring is also based on the route of administration, order of entry and designation, probability of success, and the addressable patient pool for each therapy. According to these parameters, the final weightage score and the ranking of the emerging therapies are decided.

Post-Bariatric hypoglycemia Market Access and Reimbursement

Because newly authorized drugs are often expensive, some patients escape receiving proper treatment or use off-label, less expensive prescriptions. Reimbursement plays a critical role in how innovative treatments can enter the market. The cost of the medicine, compared to the benefit it provides to patients who are being treated, sometimes determines whether or not it will be reimbursed. Regulatory status, target population size, the setting of treatment, unmet needs, the number of incremental benefit claims, and prices can all affect market access and reimbursement possibilities.

The Post-Bariatric hypoglycemia market report further provides detailed insights on the country-wise accessibility and reimbursement scenarios, cost-effectiveness scenario of approved therapies, programs making accessibility easier and out-of-pocket costs more affordable, insights on patients insured under federal or state government prescription drug programs, etc.

Post-Bariatric hypoglycemia Market Report Insights

• Post-Bariatric hypoglycemia Patient Population
• Post-Bariatric hypoglycemia Therapeutic Approaches
• Post-Bariatric hypoglycemia Market Size
• Post-Bariatric hypoglycemia Market Trends
• Existing Post-Bariatric hypoglycemia Market Opportunity

Post-Bariatric hypoglycemia Market Report Key Strengths

• Eleven-year Forecast
• The 7MM Coverage
• Post-Bariatric hypoglycemia Epidemiology Segmentation
• Patient-based Post-Bariatric hypoglycemia Market Forecasting
• Key Cross Competition

Post-Bariatric hypoglycemia Market Report Assessment

• Current Treatment Practices
• Reimbursements
• Post-Bariatric hypoglycemia Market Attractiveness
• Qualitative Analysis (SWOT, Conjoint Analysis)

Key Questions

• Would there be any changes observed in the current treatment approach?
• Will there be any improvements in Post-Bariatric hypoglycemia management recommendations?
• Would research and development advances pave the way for future tests and therapies for Post-Bariatric hypoglycemia?
• Would the diagnostic testing space experience a significant impact and lead to a positive shift in the treatment landscape of Post-Bariatric hypoglycemia?
• What kind of uptake will the new therapies witness in coming years in Post-Bariatric hypoglycemia patients and what is the expected launch date of AVEXITIDE?

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