Hypoglycemia remains the most common adverse effect associated with the use of insulin therapy for diabetes management. Recent clinical trials report that significant cardiovascular risks are associated with hypoglycemia, underscoring the importance of managing this condition. This initiative provides important information to help you better manage your patients who have experienced hypoglycemia or are at risk for hypoglycemia.
Acute hypoglycemia causes end-organ stimulation and a significant release of epinephrine, with hemodynamic changes resulting in effects on the myocardium, liver, and brain. Heart rate and peripheral systolic blood pressure increase, coinciding with reduced central blood pressure and peripheral arterial resistance, plus increased myocardial contractility, stroke volume, and cardiac output. Transient cardiac stress occurs, with potentially dangerous consequences, particularly for older individuals with type 2 diabetes who have coronary heart disease. Hypoglycemia is also associated with adverse renal effects.
The 2013 report form the Working Group of the American Diabetes Association and the Endocrine Society concluded that hypoglycemia cannot be defined as a single threshold value for plasma glucose concentration. For each individual patient, the definition of hypoglycemia must be based on that patient’s history, comorbidities, age, and personal preferences and the potential impact of hypoglycemia on his/her quality of life, among other factors.
Clinicians and patients must partner in the development of multifaceted strategies to balance the risks of both hyperglycemia and hypoglycemia. The former has been the focus of traditional interventions. However, clinicians also need to focus on the prevention of hypoglycemia through patient education, modifications to diet and exercise regiments, adjustment of medications, patient use of glucose monitoring, and regular surveillance by the clinician. The use of new agents that are associated with reduced hypoglycemic risk should be considered as part of risk-reduction strategies.
The risk of hypoglycemia should be assessed at every visit, and education concerning hypoglycemia should be provided at every clinical encounter to patients who receive treatment with insulin or insulin secretagogues.
The THRIVE initiative seeks to give clinicians important tools to address hypoglycemia in their patients and improve patient outcomes and quality of life. On this website, you will find CME activities and tools to help in your daily management of patient with diabetes.