Expert Group Recommendations on Detection and Management of Hypoglycemia in Routine Clinical Practice in Insulin Treated Patients with Diabetes

Abstract

Hypoglycemia is a key barrier to optimum glycemic control in insulin treated diabetes patients. A national level expert group meeting was held at the 11th national insulin summit to analyze published data from clinical studies and guidelines to evolve consensus recommendations on identification and management of hypoglycemia in insulin-treated diabetes patients. This consensus statement emphasizes consideration of suggestive symptoms or blood glucose levels ≤70 mg/dl and ability to self-treat in identification and classification of hypoglycemia. Patient questionnaire administration at each patient visit will enable accurate reporting of hypoglycemia. Patients with strict glycemic control, high glycemic variability, history of severe hypoglycemia, impaired hypoglycemia awareness, long duration of disease or insulin therapy could be at an increased risk of hypoglycemia. Prevention of hypoglycemia should include monitoring and goal setting, patient education, dietary intervention, exercise counseling and medication adjustment. Basal insulin analogues (vs. NPH), rapid-acting insulin analogues (vs. RHI) and premix insulin analogues (vs. BHI) are more appropriate options with superiority of insulin degludec to insulin glargine U100 and IDegAsp to BIAsp 30 to reduce the risk of hypoglycemia. This consensus statement provides practical guidance for physicians in effectively managing and minimizing the risk of hypoglycemia in insulin treated diabetes patients.