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11-02-2017 | Hypoglycemia | Practical approach | Article

Practical Approaches to Diagnosing, Treating and Preventing Hypoglycemia in Diabetes

Journal: Diabetes Therapy

Authors: Kathryn Evans Kreider, Katherine Pereira, Blanca I. Padilla

Publisher: Springer Healthcare

Abstract

Hypoglycemia in individuals with diabetes can increase the risk of morbidity and all-cause mortality in this patient group, particularly in the context of cardiovascular impairment, and can significantly decrease the quality of life. Hypoglycemia can present one of the most difficult aspects of diabetes management from both a patient and healthcare provider perspective. Strategies used to reduce the risk of hypoglycemia include individualizing glucose targets, selecting the appropriate medication, modifying diet and lifestyle and applying diabetes technology. Using a patient-centered care approach, the provider should work in partnership with the patient and family to prevent hypoglycemia through evidence-based management of the disease and appropriate education.
Literature
1.
Cryer P. Hypoglycemia in diabetes: pathophysiology, prevalence, and prevention. American Diabetes Association:Alexandria, VA. 2012.
2.
International Hypoglycaemia Study Group. Minimizing hypoglycemia in diabetes. Diabetes Care. 2015;38(8):1583–91.CrossRef
3.
Lee AK, Warren B, Lee CJ, Huang ES, Sharrett AR, Coresh J, Selvin E. Association of severe hypoglycemia with cardiovascular disease and all-cause mortality in older adults with diabetes: the atherosclerosis risk in communities (ARIC) study. Circulation. 2017;135:A43.
4.
DCCT Research Group. Epidemiology of severe hypoglycemia in the diabetes control and complications trial. Am J Med. 1991;90(4):450–9.CrossRef
5.
UK Hypoglycaemia Study Group. Risk of hypoglycaemia in types 1 and 2 diabetes: effects of treatment modalities and their duration. Diabetologia. 2007;50(6):1140–7.CrossRef
6.
Pathak RD, Schroeder EB, Seaquist ER, Zeng C, Lafata JE, Thomas A, Karter AJ. Severe hypoglycemia requiring medical intervention in a large cohort of adults with diabetes receiving care in US integrated health care delivery systems: 2005–2011. Diabetes Care. 2016;39(3):363–70.CrossRefPubMed
7.
Abraira C, Colwell JA, Nuttall FQ, Sawin CT, Nagel NJ, Comstock JP, VA CSDM Group. Veterans Affairs Cooperative Study on glycemic control and complications in type II diabetes (VA CSDM): results of the feasibility trial. Diabetes Care. 1995;18(8):1113–23.CrossRefPubMed
8.
Alexiu C, Kirkland SW, Jelinski S, Chuck A, Campbell S, Rowe BH. P112: cost of hypoglycemia associated with diabetes mellitus: a systematic review of the literature. CJEM. 2016;18(S1):S115.
9.
Foos V, Varol N, Curtis BH, Boye KS, Grant D, Palmer JL, McEwan P. Economic impact of severe and non-severe hypoglycemia in patients with type 1 and type 2 diabetes in the United States. J Med Econ. 2015;18(6):420–32.CrossRefPubMed
10.
Marrett E, Radican L, Davies MJ, Zhang Q. Assessment of severity and frequency of self-reported hypoglycemia on quality of life in patients with type 2 diabetes treated with oral antihyperglycemic agents: a survey study. BMC Res Notes. 2011;4(1):251.CrossRefPubMedPubMedCentral
11.
McCoy R, Van Houten H, Ziegenfuss J, Shah N, Wermers R, Smith S. Self-report of hypoglycemia and health-related quality of life in patients with type 1 and type 2 diabetes. Endocr Pract. 2013;19(5):792–9.CrossRefPubMed
12.
McGill DE, Levitsky LL. Management of hypoglycemia in children and adolescents with type 1 diabetes mellitus. Curr Diabetes Rep. 2016;16(9):88.CrossRef
13.
Khunti K, Davies M, Majeed A, Thorsted BL, Wolden ML, Paul SK. Hypoglycemia and risk of cardiovascular disease and all-cause mortality in insulin-treated people with type 1 and type 2 diabetes: a cohort study. Diabetes Care. 2015;38(2):316–22.CrossRefPubMed
14.
Frier BM, Schernthaner G, Heller SR. Hypoglycemia and cardiovascular risks. Diabetes Care. 2011;34[Suppl 2]:S132–7.CrossRefPubMedPubMedCentral
15.
Bonds DE, Miller ME, Bergenstal RM, et al. The association between symptomatic, severe hypoglycaemia and mortality in type 2 diabetes: retrospective epidemiological analysis of the ACCORD study. BMJ. 2010;340:b4909.CrossRefPubMedPubMedCentral
16.
Skrivarhaug T, Bangstad HJ, Stene LC, Sandvik L, Hanssen KF, Joner G. Longterm mortality in a nationwide cohort of childhood-onset type 1 diabetic patients in Norway. Diabetologia. 2006;49:298–305.CrossRefPubMed
17.
Kreider KE, Padilla BI, Pereira K. Hypoglycemia in diabetes: challenges and opportunities in care. J Nurse Pract. 2017;13(3):228–34.CrossRef
18.
Cano N. Bench-to-bedside review: glucose production from the kidney. Crit Care. 2002;6(4):317.CrossRefPubMedPubMedCentral
19.
Seaquist ER, Anderson J, Childs B, Cryer P, Dagogo-Jack S, Fish L, et al. Hypoglycemia and diabetes: a report of a workgroup of the American Diabetes Association and The Endocrine Society. Diabetes Care. 2013;36(5):1384–95.CrossRefPubMedPubMedCentral
20.
Reno CM, Litvin M, Clark AL, Fisher SJ. Defective counterregulation and hypoglycemia unawareness in diabetes: mechanisms and emerging treatments. Endocrinol Metab Clin North Am. 2013;42(1):15.CrossRefPubMed
21.
Bakatselos SO. Hypoglycemia unawareness. Diabetes Res Clin Pract. 2011;93:S92–6.CrossRefPubMed
22.
Cryer PE. Mechanisms of hypoglycemia-associated autonomic failure in diabetes. N Engl J Med. 2013;369(4):362–72.CrossRefPubMed
23.
Marso SP, McGuire DK, Zinman B, Poulter NR, Emerson SS, Pieber TR, Moses A. Efficacy and safety of degludec versus glargine in type 2 diabetes. N Engl J Med. 2017; 377:723–32.
24.
Snyder RW, Berns JS. Reviews: use of insulin and oral hypoglycemic medications in patients with diabetes mellitus and advanced kidney disease. Semin Dial. 2004; 17(5):365–70.
25.
Tsujimoto T, Sugiyama T, Shapiro MF, Noda M, Kajio H. Risk of cardiovascular events in patients with diabetes mellitus on B-blockers. Hypertension. 2017;70:103–10.CrossRefPubMed
26.
Murad MH, Coto-Yglesias F, Wang AT, et al. Drug-induced hypoglycemia: a systematic review. J Clin Endocrinol Metab. 2009;94(3):741–5.CrossRefPubMed
27.
Zaharieva DP, Riddell MC. Prevention of exercise-associated dysglycemia: a case study-based approach. Diabetes Spectr. 2015;28(1):55–62.CrossRefPubMedPubMedCentral
28.
Donner T. Insulin—pharmacology, therapeutic regimens and principles of intensive insulin therapy. 2015. In: De Groot LJ, Chrousos G, Dungan K, et al., editors. South Dartmouth (MA): MDText.com, Inc.; 2000.
29.
Inzucchi SE, Bergenstal RM, Buse JB, et al. Management of hyperglycemia in type 2 diabetes, 2015: a patient-centered approach: update to a position statement of the American Diabetes Association and the European Association for the Study of Diabetes. Diabetes Care. 2015;38(1):140–9.CrossRefPubMed
30.
Rodbard D. Continuous glucose monitoring: a review of successes, challenges, and opportunities. Diabetes Technol Ther. 2016;18[Suppl 2]:S2-3–13.CrossRef
31.
Centers for Medicare and Medicaid Services. Classification of therapeutic continuous glucose monitors as “Durable Medical Equipment” under Medicare Part B. https://​www.​cms.​gov/​Regulations-and-Guidance/​Guidance/​Rulings/​Downloads/​CMS1682R.​pdf (2017). Accessed 23 Oct 2017.
32.
Bergenstal RM, Klonoff DC, Garg SK, et al. Threshold-based insulin-pump interruption for reduction of hypoglycemia. N Engl J Med. 2013;369(3):224–32. doi:10.​1056/​NEJMoa1303576.CrossRefPubMed
33.
Garg SK, Weinzimer SA, Tamborlane WV, Buckingham BA, Bode BW, Bailey TS, Bergenstal RM. Glucose outcomes with the in-home use of a hybrid closed-loop insulin delivery system in adolescents and adults with type 1 diabetes. Diabetes Technol Ther. 2017;19(3):155–63.CrossRefPubMedPubMedCentral
34.
Ranjan A, Schmidt S, Madsbad S, Holst JJ, Nørgaard K. Effects of subcutaneous, low-dose glucagon on insulin-induced mild hypoglycaemia in patients with insulin pump treated type 1 diabetes. Diabetes Obes Metab. 2016;18(4):410–8.CrossRefPubMed
35.
Boyle PJ, Zrebiec J. Management of diabetes-related hypoglycemia. South Med J. 2007;100(2):183–94.CrossRefPubMed
36.
Cryer PE, Axelrod L, Grossman AB, Heller SR, Montori VM, Dequist ER, Service FJ. Evaluation and management of adult hypoglycemic disorders: an endocrine society clinical practice guideline. J Clin Endocrinol Metab. 2009;94(3):709–28.CrossRefPubMed
37.
Horton ES, Shahar J. Exercise for fitness. In: Beaser RS (ed) Joslin’s diabetes deskbook: a guide for primary care providers. 3rd ed. Boston: Joslin Diabetes Center; 2014. p. 155–85.

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