Hypoglycemia in type 2 diabetes: Standpoint of an experts′ committee (India hypoglycemia study group)

Abstract

The epidemic of type 2 diabetes and the recognition that achieving specific glycemic goals can substantially reduce morbidity have made the effective treatment of hyperglycemia a top priority. Despite compelling evidence that tight glycemic control is crucial for delaying disease progression, increased risk of hypoglycemia associated with such control underscore the complexity of diabetes management. In most cases, hypoglycemia results from an excess of insulin, either absolute or relative to the available glucose substrate and the factors perhaps exacerbating the risk are pharmacokinetic imperfections, behavioral, co-morbidities etc. Additionally, many patients remain undiagnosed, and many diagnosed patients are not treated appropriately. In this article, the challenges of hypoglycemia, confronting health care providers and their patients with diabetes, are discussed for making treatment decisions that will help minimize risk of hypoglycemia and eventually overcome formidable barriers to optimal diabetes management. Strategies to treat and minimize the frequency and severity of hypoglycemia without compromising on glycemic goals are also presented.

Knowledge of hypoglycemia and its associated factors among type 2 diabetes mellitus patients in a Tertiary Care Hospital in South India

“…In India, which has the second largest number of diabetes patients, there is negligible data on the epidemiology of hypoglycemia. [ 15 ] The limitation of the study is that the knowledge is assessed among patients attending a diabetes free Clinic in a Medical College Hospital and may not be accurately representing that in a community comprising both affordable and poor patients.…”

Reported hypoglycemia in Type 2 diabetes mellitus patients: Prevalence and practices-a hospital-based study

“…[9] The list of common symptoms of hypoglycemia was made by wide literature search. [710121314] The patients were enquired whether they had any of the listed hypoglycemic symptoms in the past 1 year.…”

“…[8] The India Hypoglycemia Study Group highlights that there is negligible data on the epidemiology of hypoglycemia in type 2 diabetes from India, which has the second largest number of diabetes patients in the world. [9] The ADA workgroup on hypoglycemia has reported a condition, “Probable Symptomatic Hypoglycemia” where there are typical symptoms of hypoglycemia without a measured plasma glucose concentration. According to them, even though these conditions may not be suitable outcome measures for clinical studies evaluating therapy, it would be useful to report such episodes.…”

Hypoglycaemia in diabetes: do we think enough of the cause? An observational study on prevalence and causes of hypoglycaemia among patients with type 2 diabetes in an out-patient setting in Sri Lanka

“…Disabling and life threatening micro and macrovascular complications of diabetes highlights the need for optimum management [ 2 ]. Benefits of intensive glycaemic control in prevention of these complications are well recognized [ 3 , 4 ]. However it has been observed that most patients do not reach the optimum level of glycaemic control despite well defined management protocols [ 4 ].…”

“…Benefits of intensive glycaemic control in prevention of these complications are well recognized [ 3 , 4 ]. However it has been observed that most patients do not reach the optimum level of glycaemic control despite well defined management protocols [ 4 ]. This, at least partly, is attributable to the fear of hypoglycaemia, both among patients and treating medical professionals [ 5 ].…”