Annals of Clinical Nutrition and Metabolism

Review Article

Mechanistic insights, clinical significance, and management strategies for postgastrectomy hypoglycemia in gastric cancer patients in the era of continuous glucose monitoring: a narrative review: Cheong Ah Oh; Ann Clin Nutr Metab 2026;18(2):117-126. Published online July 31, 2026; DOI: https://doi.org/10.15747/ACNM.25.0035

Abstract PDF: Purpose
Postgastrectomy hypoglycemia (PGH) is increasingly recognized as a potential metabolic complication after gastrectomy for gastric cancer. This narrative review summarizes its clinical relevance, underlying mechanisms, and management strategies in the era of continuous glucose monitoring.
Current concept
Traditionally considered part of the spectrum of late dumping syndrome, PGH arises from rapid nutrient transit, which leads to postprandial hyperglycemia followed by exaggerated insulin secretion and subsequent hypoglycemia. Emerging evidence suggests that glycemic disturbances after gastrectomy extend beyond symptomatic postprandial events to include asymptomatic and nocturnal hypoglycemia, as well as marked glycemic variability. Proposed mechanisms include postprandial hyperinsulinemia mediated by incretin hormones, particularly glucagon-like peptide-1, peptide YY, and glucose-dependent insulinotropic polypeptide. These disturbances may contribute to fatigue, impaired concentration, nutritional deterioration, and increased vulnerability to adverse events. Dietary modification, including frequent small meals emphasizing low–glycemic-index carbohydrates with adequate protein and fiber, remains the cornerstone of management. Pharmacologic interventions may be considered in refractory cases, although evidence specific to PGH remains limited and is often extrapolated from related conditions.
Conclusion
PGH after gastrectomy for gastric cancer is an underrecognized but clinically meaningful metabolic disturbance. Greater awareness and individualized management are essential to mitigate long-term nutritional and functional consequences. Further research is needed to clarify its mechanisms and establish evidence-based management strategies.

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