ClinicalTrials.gg
Active, not recruitingNCT03385707Updated Feb 6, 2026

Hypoglycemia and the Gut Microbiome

An observational study in Hypoglycemia, sponsored by Joslin Diabetes Center. Active, not recruiting at 1 site in United States. Open to participants aged 18 Years to 65 Years. Per ClinicalTrials.gov, last updated 2026-02-06.

Sponsored by Joslin Diabetes Center · Observational

Study type
Observational
Model
Case-only
Time perspective
Cross-sectional
Enrollment
28
Ages
18 Years to 65 Years
Sex
All
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Study summary

This study is designed to evaluate individuals who are currently experiencing symptoms of hypoglycemia, in order to discern correlations between microbiome composition and patterns of postprandial glycemia.

Read the detailed description

Recent studies have shown that analysis of the gastrointestinal microbiome can be used to predict glycemic response to dietary intake. Specifically, integrative analysis of dietary consumption, anthropometrics, physical activity and gut microbiota composition can be used to predict postprandial glycemic excursions. The investigators hypothesize that individualized assessment of glycemic responses to food, together with analysis of the gut microbiome, will allow the design of a personalized dietary approach to minimize glycemic excursions for patients with post-bariatric and other forms of largely postprandial hypoglycemia. Identification of factors predictive of glycemic excursions and subsequent hypoglycemia may ultimately allow individuals to tailor their diet towards foods which would not induce hypersecretion of insulin and subsequent hypoglycemia.

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Conditions studied

  • Hypoglycemia

Browse trials for

Keywords

  • Post-bariatric hypoglycemia
03

In context

Hypoglycemia

706 studies on the registry are indexed under Hypoglycemia; 94 are open to participants now.

This study's planned enrollment of 28 is below the median of 86 across 131 observational studies indexed under Hypoglycemia.

Browse Hypoglycemia studies →

Lead sponsor

Joslin Diabetes Center is the lead sponsor of 80 studies on the registry; 7 are open to participants now.

Counted across the registry records on this site, refreshed daily.

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Who can participate

Ages eligible
18 Years to 65 Years
Sexes eligible
All
Accepts healthy volunteers
No
Sampling method
Non-probability sample

Study population

Patients who experience hypoglycemia after bariatric or other upper gastrointestinal surgery or those with reactive hypoglycemia in the absence of surgery.

Go through the criteria one by one — yes, no or not sure — and take the list to your doctor or the study team. Kept in this browser only.

Inclusion criteria

  1. Males or females diagnosed with ongoing post-bariatric, post-gastric surgery or other forms of postprandial hypoglycemia with prior episodes of neuroglycopenia
  2. Age 18-65 years of age, inclusive, at screening.
  3. Willingness to provide and follow all study procedures, including attending all scheduled visits.

Exclusion criteria

Exclusion Criteria

  1. Documented hypoglycemia occurring in the fasting state (> 12 hours fast);
  2. Chronic kidney disease stage 4 or 5 (including end-stage renal disease);
  3. Hepatic disease, including serum (ALT) or aspartate aminotransferase (AST) greater than or equal to 3 times the ; hepatic synthetic insufficiency as defined as serum albumin \< 3.0 g/dL; or serum > 2.0;
  4. Congestive heart failure, (NYHA) class II, III or IV;
  5. History of myocardial infarction, unstable angina or revascularization within the past 6 months or 2 or more risk factors for coronary artery disease including diabetes, uncontrolled hypertension, uncontrolled hyperlipidemia, and active tobacco use.
  6. History of syncope (unrelated to hypoglycemia) or diagnosed cardiac arrhythmia
  7. Concurrent administration of β-blocker therapy;
  8. History of a cerebrovascular accident;
  9. Seizure disorder (other than with suspect or documented hypoglycemia);
  10. Active treatment with any diabetes medications except for acarbose;
  11. Active treatment with octreotide or diazoxide;
  12. Active , except basal cell or squamous cell skin cancers;
  13. Personal or family history of pheochromocytoma or disorder with increased risk of pheochromocytoma (MEN 2, neurofibromatosis, or Von Hippel-Lindau disease);
  14. Known insulinoma;
  15. Major surgical operation within 30 days prior to screening;
  16. Hematocrit \< 33%;
  17. Bleeding disorder, treatment with warfarin, or count \<50,000;
  18. Blood donation (1 pint of whole blood) within the past 2 months;
  19. Active alcohol abuse or substance abuse;
  20. Current administration of oral or parenteral ;
  21. Pregnancy and/ or lactation: For women of : there is a requirement for a negative urine pregnancy test and for agreement to use during the study and for at least 1 month after participating in the study. Acceptable contraception includes birth control pill / patch / vaginal ring, Depo-Provera, Norplant, an intrauterine device (IUD), the double barrier method (the woman uses a diaphragm and spermicide and the man uses a condom), or abstinence.
  22. Use of an drug within 30 days prior to screening.
Terms in these criteria, in plain language(11)

Underlined terms in the criteria open these too. Explained by clinicaltrials.gg, not part of the registry record. The study team decides who can take part.

Informed consent

Before you join, the study team explains what taking part involves — its purpose, what happens, the risks and possible benefits — and answers your questions, so you can decide freely. Consent is usually recorded on a form (the informed consent form, ICF) signed by you or, where the law allows, by someone legally authorised to decide for you.

You can keep asking questions during the study, you are told of new information that matters, and you can choose to leave at any time.

ALT and AST (liver enzymes)

Two enzymes measured in a routine blood test of the liver. Higher levels can mean the liver is under strain or damaged. SGPT and SGOT are older names for ALT and AST.

Criteria usually give a limit as a multiple of the upper limit of normal (ULN), often higher when cancer has spread to the liver.

ULN (upper limit of normal)

The top of the normal range for a blood test, as set by the laboratory that runs it. Each lab prints its own range next to your result.

“≤ 2.5 × ULN” means the result can be up to two and a half times that top value.

Bilirubin

A yellow substance made when red blood cells are broken down, which the liver clears. A high level can mean a problem with the liver or the bile ducts.

Criteria often allow more for people with Gilbert’s syndrome, a harmless inherited condition that raises bilirubin.

NYHA class (heart failure)

The New York Heart Association’s four classes of how much heart failure limits physical activity.

I
No limits: ordinary activity causes no undue tiredness or breathlessness.
II
Slight limits: comfortable at rest, ordinary activity causes symptoms.
III
Marked limits: comfortable at rest, less than ordinary activity causes symptoms.
IV
Symptoms even at rest; any activity makes them worse.

Studies set their own limit — many outside heart failure leave out class III–IV, while heart failure studies may ask for a particular class. Check the class this study names.

Cancer (malignancy)

Malignancy means cancer. Criteria about another or earlier malignancy ask whether you have had a different cancer, usually within a set number of years.

Some are commonly allowed, such as treated skin cancers other than melanoma and early cancers removed completely — check the exceptions this study lists.

Platelets

Blood cells that help blood clot. Too few raises the risk of bleeding and bruising. A usual adult range is about 150–400 × 10⁹/L (150,000–400,000 per µL); each lab has its own reference range.

Corticosteroids (steroids)

Anti-inflammatory medicines such as prednisone, prednisolone and dexamethasone — not the anabolic steroids used for muscle.

Studies differ in what they allow: check which steroid medicines, routes (tablets, injections, creams, inhalers, eye drops) and doses this study accepts.

Childbearing potential

Able to become pregnant: from the first period until menopause, unless permanently unable to through surgery (removal of the womb, or of both ovaries or both fallopian tubes).

Criteria for people of childbearing potential usually ask for a negative pregnancy test and for contraception during the study and for a time after it.

Contraception

Ways of preventing pregnancy. “Highly effective” methods fail less than 1% of the time a year when used correctly — for example an IUD or an implant.

Criteria usually say which methods count and how long to keep using them after the last dose, sometimes for male participants too. Some studies accept a partner’s vasectomy if it was confirmed successful and that person is the participant’s only sexual partner.

Investigational drug or device

A drug or device being studied in a clinical trial.

It may be new, or already approved and being studied for another use, dose or form. Criteria often leave out people who took part in another study of one within a recent period, commonly 30 days or five half-lives.

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Study design

Observational model
Case-only
Time perspective
Cross-sectional
Enrollment
28 participants (estimated)
Patient registry
No
Biospecimen retention
Samples with dna

Groups and cohorts

  • CGM and Microbiota

    Participants will wear a Dexcom continuous glucose monitor (CGM) and activity monitor for two weeks. They will not be aware of sensor glucose values. A stool sample will be collected. The investigators will evaluate relationships between patterns of postprandial glycemia, recorded by CGM, food intake, and microbiome composition.

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What researchers measure

Primary outcomes

  1. Analysis of cumulative duration of hypoglycemia

    Duration of hypoglycemia will be assessed by: (1) the number of minutes per day with hypoglycemia, defined as sensor glucose \<70 mg/dl, and (2) the number of minutes per day of severe hypoglycemia, defined as sensor glucose \<55 mg/dl. Data will be captured for the entire 24 hour period as well as day and night subsets.

    Time frame: 2 weeks

Secondary outcomes

  1. Analysis of frequency of glycemic excursions

    Hypoglycemia frequency will be assessed by: (1) number of episodes of hypoglycemia, both moderate (55-70 mg/dl) and severe (\<55 mg/dl), (2) number of episodes requiring assistance, and (4) number of episodes of hyperglycemia (\>180 mg/dl). All data will be averaged and reported as episodes per day.

    Time frame: 2 weeks

  2. Impact of activity on glycemic patterns in post-bariatric hypoglycemia

    Activity measures (total step number per day) will be analyzed to determine relationship to changes in sensor glucose levels. Data will be integrated to determine relationships between glycemic patterns, diet, and microbiome.

    Time frame: 2 weeks

  3. Impact of diet on glycemic patterns in post-bariatric hypoglycemia

    Dietary information will be transcribed and recorded from participants' food diaries. Data will be integrated to determine relationships between glycemic patterns, diet, and microbiome.

    Time frame: 2 weeks

  4. Analysis of microbiome in individuals with post-bariatric hypoglycemia

    Stool samples will be analyzed to determine microbiome community by 18S sequencing. Data will be integrated to determine relationships between glycemic patterns, diet, and microbiome.

    Time frame: 2 weeks

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Study locations

1 site
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References and documents

Publications

  • Patti ME, Goldfine AB. The rollercoaster of post-bariatric hypoglycaemia. Lancet Diabetes Endocrinol. 2016 Feb;4(2):94-6. doi: 10.1016/S2213-8587(15)00460-X. Epub 2015 Dec 15. No abstract available. PubMed 26701701 ↗
  • Mulla CM, Middelbeek RJW, Patti ME. Mechanisms of weight loss and improved metabolism following bariatric surgery. Ann N Y Acad Sci. 2018 Jan;1411(1):53-64. doi: 10.1111/nyas.13409. Epub 2017 Sep 3. PubMed 28868615 ↗
  • Suhl E, Anderson-Haynes SE, Mulla C, Patti ME. Medical nutrition therapy for post-bariatric hypoglycemia: practical insights. Surg Obes Relat Dis. 2017 May;13(5):888-896. doi: 10.1016/j.soard.2017.01.025. Epub 2017 Jan 16. PubMed 28392017 ↗

Individual participant data

Plan to share: No

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Updates

Tracking since Sep 25, 2026
No changes since tracking began. The registry record was last updated on Feb 6, 2026, before this site started recording changes on Sep 25, 2026. Its history is on ClinicalTrials.gov ↗
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Registry details

Key details

Study ID
NCT03385707
Lead sponsor
Joslin Diabetes Center
Responsible party
Sponsor
First posted
Dec 28, 2017
Start date
Feb 7, 2019
Primary completion
Nov 1, 2026 (estimated)
Completion
Nov 1, 2026 (estimated)
Last update
Feb 6, 2026

Study contacts

Mary E Patti, MD
principal investigator · Joslin Diabetes Center

Oversight

FDA-regulated drug
No
FDA-regulated device
No
View the source record on ClinicalTrials.gov ↗

Not currently enrolling

This study is active, not recruiting, as verified in Feb 2026. You cannot join it, but the record below documents what was studied.

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Discussion

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