Charlottesville, VA—Hypoglycemia is one of the top three preventable adverse drug reactions, according to the U.S. Department of Health and Human Services. Hypoglycemic events lead to 100,000 emergency department (ED) visits each year and cost about $120 million annually.

That is why new Clinical Practice Guidelines issued recently by the Endocrine Society are focused on lowering the rates of hypoglycemia. The guideline, entitled “Management of Individuals with Diabetes at High Risk for Hypoglycemia: An Endocrine Society Clinical Practice Guideline,” was published online and will appear in the March 2023 issue of the Journal of Clinical Endocrinology & Metabolism (JCEM).

The Endocrine Society pointed out that dangerously low blood sugar in diabetes patients can cause unconsciousness or seizures. It added that the condition can significantly affect the quality of life, social life, work productivity, and ability to drive safely. It additionally noted that hypoglycemia is relatively common in type 1 diabetes (T1D) patients and in those with type 2 diabetes (T2D) who are prescribed insulin or sulfonylureas.

This guideline updates the Society’s 2009 inpatient hypoglycemia guideline. Among its recommendations is the use of new insulins and forms of glucagon to treat and manage hypoglycemia more effectively. It also endorses advancements in continuous glucose monitoring (CGM) and insulin pump technology.

“CGMs and insulin pumps have been much more commonly used in the last decade among people with diabetes including children, and there are new forms of glucagon available. We had to update our guideline to match these developments in the diabetes field,” stated guideline panel chair Anthony L. McCall, MD, PhD, of the University of Virginia in Charlottesville, adding, “People with diabetes, their caregivers and diabetes specialists will all benefit from our guideline with a better understanding of best practices and interventions.”

Key recommendations from the guideline include:

• Prescribing easier-to-use formulations of glucagon for patients with severe hypoglycemia
• Employing CGM instead of self-monitoring of blood glucose by fingerstick for patients with T1D who receive multiple daily injections
• Improving inpatient glycemic surveillance and management programs using electronic health record data for inpatients at risk for hypoglycemia
• Launching structured patient education programs for adult and pediatric patients with T1D or T2D receiving insulin therapy.

“Hypoglycemia in people with diabetes is common, especially in those taking medications such as insulin and sulfonylureas (SU) that place them at higher risk,” the authors explained. “Hypoglycemia is associated with distress in those with diabetes and their families, medication nonadherence, and disruption of life and work, and it leads to costly emergency department visits and hospitalizations, morbidity, and mortality.”

In developing the guideline, the panel agreed on 10 questions specific to hypoglycemia risk and prevention in people with diabetes for which 10 recommendations were made. The guideline included conditional recommendations for use of real-time CGM and algorithm-driven insulin pumps in people with T1D and the use of CGM for outpatients with T2D at high risk for hypoglycemia. It also endorses the use of long-acting and rapid-acting insulin analogs and initiation of and continuation of CGM for select inpatient populations at high risk for hypoglycemia.

“Strong recommendations were made for structured diabetes education programs for those at high risk for hypoglycemia, use of glucagon preparations that do not require reconstitution vs those that do for managing severe outpatient hypoglycemia for adults and children, use of real-time CGM for individuals with T1D receiving multiple daily injections, and the use of inpatient glycemic management programs leveraging electronic health record data to reduce the risk of hypoglycemia,” according to the report.

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