Hypoglycaemia and its management in primary care setting

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Ibrahim , M , Baker , J , Cahn , A , Eckel , R H , Sayed , N A E , Fischl , A H , Gaede , P , Leslie , R D , Pieralice , S , Tuccinardi , D , Pozzilli , P , Richelsen , B , Roitman , E , Standl , E , Toledano , Y , Tuomilehto , J , Weber , S L & Umpierrez , G E 2020 , ' Hypoglycaemia and its management in primary care setting ' , Diabetes / Metabolism Research and Reviews , vol. 36 , no. 8 , 3332 . https://doi.org/10.1002/dmrr.3332

Title: Hypoglycaemia and its management in primary care setting
Author: Ibrahim, Mahmoud; Baker, Jason; Cahn, Avivit; Eckel, Robert H.; Sayed, Nuha Ali El; Fischl, Amy Hess; Gaede, Peter; Leslie, R. David; Pieralice, Silvia; Tuccinardi, Dario; Pozzilli, Paolo; Richelsen, Bjørn; Roitman, Eytan; Standl, Eberhard; Toledano, Yoel; Tuomilehto, Jaakko; Weber, Sandra L.; Umpierrez, Guillermo E.
Contributor: University of Helsinki, Clinicum
Date: 2020-11
Language: eng
Number of pages: 21
Belongs to series: Diabetes / Metabolism Research and Reviews
ISSN: 1520-7552
URI: http://hdl.handle.net/10138/329449
Abstract: Abstract Hypoglycemia is common in patients with type 1 diabetes (T1D) and type 2 diabetes (T2D) and constitutes a major limiting factor in achieving glycemic control among people with diabetes. While hypoglycemia is defined as a blood glucose level under 70 mg/dL (3.9?mmol/L), symptoms may occur at higher blood glucose levels in individuals with poor glycemic control. Severe hypoglycemia is defined as an episode requiring the assistance of another person to actively administer carbohydrate, glucagon, or take other corrective actions to assure neurologic recovery. Hypoglycemia is the most important safety outcome in clinical studies of glucose lowering agents. The ADA Standards of Medical Care recommends that a management protocol for hypoglycemia should be designed and implemented by every hospital, along with a clear prevention and treatment plan. A tailored approach, using clinical and pathophysiologic disease stratification, can help individualize glycemic goals and promote new therapies to improve quality of life of patients. Data from recent large clinical trials reported low risk of hypoglycemic events with the use of newer antidiabetic drugs. Increased hypoglycemia risk is observed with the use of insulin and/or sulfonylureas. Vulnerable patients with T2D at dual risk of severe hypoglycemia and Cardiovascular (CV) outcomes show features of ?frailty?. Many of such patients may be better treated by the use of GLP-1 receptor agonists or SGLT2 inhibitors rather than insulin. CGM should be considered for all individuals with increased risk for hypoglycemia, impaired hypoglycemia awareness, frequent nocturnal hypoglycemia and with history of severe hypoglycemia. Patients with impaired awareness of hypoglycemia (IAH) benefit from real-time continuous glucose monitoring (CGM). The diabetes educator is an invaluable resource and can devote the time needed to thoroughly educate the individual to reduce the risk of hypoglycemia and integrate the information within the entire construct of diabetes self-management. Conversations about hypoglycemia facilitated by a healthcare professional may reduce the burden and fear of hypoglycemia among patients with diabetes and their family members. Optimizing insulin doses and carbohydrate intake, in addition to a short warm up before or after the physical activity sessions may help avoiding hypoglycemia. Several therapeutic considerations are important to reduce hypoglycemia risk during pregnancy including administration of rapid-acting insulin analogs rather than human insulin, pre-conception initiation of insulin analogs, and immediate postpartum insulin dose reduction. This article is protected by copyright. All rights reserved.
Subject: 3121 General medicine, internal medicine and other clinical medicine
Diabetes
Diabetes Self-management Education
Hypoglycemia
hypoglycemia unawareness Pregnancy
Continuous glucose monitoring (CGM)
Technology
DEPENDENT DIABETES-MELLITUS
GLYCEMIC CONTROL
hypoglycaemia
diabetes self-management education
OPEN-LABEL
technology
GLUCOSE-SENSING TECHNOLOGY
IMPAIRED AWARENESS
AUTONOMIC FAILURE
COGNITIVE DYSFUNCTION
hypoglycaemia unawareness pregnancy
PREGNANT-WOMEN
continuous glucose monitoring
diabetes
INTENSIVE INSULIN THERAPY
REAL-TIME
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