Hypoglycaemia in diabetes mellitus: epidemiology and clinical implications

Abstract

Hypoglycaemia is a frequent adverse effect of treatment of diabetes mellitus with insulin and sulphonylureas. Fear of hypoglycaemia alters self-management of diabetes mellitus and prevents optimal glycaemic control. Mild (self-treated) and severe (requiring help) hypoglycaemia episodes are more common in type 1 diabetes mellitus but people with insulin-treated type 2 diabetes mellitus are also exposed to frequent hypoglycaemic events, many of which occur during sleep. Hypoglycaemia can disrupt many everyday activities such as driving, work performance and leisure pursuits. In addition to accidents and physical injury, the morbidity of hypoglycaemia involves the cardiovascular and central nervous systems. Whereas coma and seizures are well-recognized neurological sequelae of hypoglycaemia, much interest is currently focused on the potential for hypoglycaemia to cause dangerous and life-threatening cardiac complications, such as arrhythmias and myocardial ischaemia, and whether recurrent severe hypoglycaemia can cause permanent cognitive impairment or promote cognitive decline and accelerate the onset of dementia in middle-aged and elderly people with diabetes mellitus. Prevention of hypoglycaemia is an important part of diabetes mellitus management and strategies include patient education, glucose monitoring, appropriate adjustment of diet and medications in relation to everyday circumstances including physical exercise, and the application of new technologies such as real-time continuous glucose monitoring, modified insulin pumps and the artificial pancreas.

Hypoglycaemia, thrombosis and vascular events in diabetes

“…Estimates of severe hypoglycemia (defined as the need for third-party assistance) in type 1 diabetes (T1DM) vary from 0.98 to 3.2 episodes per patient per year, affecting 22-46% of patients over a 12-month period [1]. Landmark trials such as the DCCT in T1DM [2] and UKPDS in type 2 diabetes (T2DM) demonstrated that improved glucose control leads to a clear reduction in microvascular complications in the medium/long term and a probable reduction in macrovascular disease in the long term but at the expense of an increase in hypoglycemia rates [3,4].…”

Critérios de decisão para a definição de exames médicos ocupacionais em atividades críticas: proposição de modelo e exemplos de aplicação no trabalho em altura

“…Alterações de equilíbrio, coordenação, visão e nível de consciência decorrentes da hipoglicemia podem precipitar quedas e ferimentos [48][49][50] .…”

Hypoglycemia with New Generation Basal Analog Insulins: A Descriptive Critical Review

“…As well as accidents and physical injury, the sequelae of hypoglycemia involve neurologic and cardiovascular complications discussed above [39]. Although reported rates of hypoglycemia in clinical trials vary considerably because of differences in study design, definitions used, and population included (among other factors) [40], a recent nonrandomized retrospective study using real-world outcomes from patients treated with Gla-100 or IDet in the United States suggested a rate of hypoglycemia of ~8% [41].…”