Introduction: The term “reactive” hypoglycemia, also known as post-prandial hypoglycemia has been loosely defined in the literature. The term refers to the occurrence of autonomic symptoms including weakness, perspiration, hunger, nausea, anxiety and tremors occurring one to two hours after ingestion of a meal. This collection of symptoms has been described in various patient groups including patients with impaired glucose tolerance, dumping syndrome following gastric surgeries (e.g. Nissen fundoplication, Billroth II and Roux en Y gastric bypass) and in patients in whom no specific cause has been identified. These autonomic symptoms have been reported in patients with and without documented hypoglycemia. This suggests that factors other than hypoglycemia may also be involved in the pathogenesis of this disorder.
Data extraction: English-language articles that presented data relevant to the treatment of reactive hypoglycemia were identified in a MEDLINE search from 1966 to 2011. References of these articles and other publications were also reviewed. Search terms were reactive hypoglycemia, functional hypoglycemia, post-prandial hypoglycemia, Nissen fundoplication, Billroth procedure, gastric banding, Roux en Y occurring in association with the term hypoglycemia. Studies were included for review if they evaluated the clinical use of acarbose for the treatment of this syndrome and did not meet our exclusion criteria.
Evidence synthesis: Five case reports and four small controlled trials met our inclusion criteria which examined the use of acarbose in the treatment of reactive hypoglycemia.
Conclusion: We suggest the term Post-Prandial Syndrome (PPS) rather than reactive hypoglycemia since hypoglycemia is often not documented in patients who nevertheless experience postprandial autonomic symptoms. Acarbose is often used for the treatment of postprandial syndrome, but the evidence for its effectiveness is sparse and not definitive. Although acarbose does cause a statistically significant increase in the post-prandial glucose nadir after sucrose ingestion under experimental conditions, the effect is minimal and may not be clinically significant. There are currently no high-quality placebo-controlled clinical trials for the treatment of this syndrome. Further studies are needed to evaluate the potential therapeutic benefit of acarbose in the treatment of PPS.