The importance of hypoglycemia in diabetic patients

Journal of Diabetes & Metabolic Disorders

Bagher Larijani¹  Mohammad Pajouhi¹  Mohammadreza Mohajeri-Tehrani¹  Gita Shafiee¹ 

[1] Endocrinology and Metabolism Research Center, Tehran University of Medical Sciences, Shariati Hospital, North Kargar Street, 14114, Tehran, Iran

关键词: Complications;    Hypoglycemia;    Diabetes;   

Others  :  807226
DOI  :  10.1186/2251-6581-11-17

 received in 2012-07-18, accepted in 2012-07-18,  发布年份 2012

【 摘 要 】

Hypoglycemia is one of the most important complications of diabetes treatment. The risk of severe hypoglycemia is higher in elderly patients, those having comorbidities such as vascular disease or renal failure, pregnant women and in children with type 1diabetes. Moreover, in type 2 diabetes, progressive insulin deficiency, longer duration of diabetes, and tight glycemic control increase the risk of hypoglycemia as much as type 1 diabetes.Episodes hypoglycemia may lead to impairment of counter-regulatory system, with the potential of development of hypoglycemia unawareness. So, hypoglycemia may increase the vascular events even death in addition to other possible detrimental effects. Glycemic control should be individualized based on patient characteristics with some degree of safety. Recognition of hypoglycemia risk factors, blood glucose monitoring, selection of appropriate regimens and educational programs for healthcare professionals and patients with diabetes are the major issues to maintain good glycemic control, minimize the risk of hypoglycemia, and prevent long- term complications.

【 授权许可】

   
2012 Shafiee et al.; licensee BioMed Central Ltd.

【 参考文献 】

• [1]Association AD: Standards of Medical Care in Diabetes—2011. Diabetes Care 2011, 34:S11-S61.
• [2]Alberti KG, Zimmet P, Shaw J: International Diabetes Federation: a consensus on Type 2 diabetes prevention. Diabet Med 2007, 24:451-463.
• [3]Esteghamati A, Gouya MM, Abbasi M, et al.: Prevalence of diabetes and impaired fasting glucose in the adult population of Iran: National Survey of Risk Factors for Non-Communicable Diseases of Iran. Diabetes Care 2008, 31:96-98.
• [4]Abolhasani F, Mohajeri Tehrani MR, Tabatabaei O, et al.: Burden of Diabetes and Its Complications in Iran in Year 2000. Iranian Journal of Diabetes and Lipid Disorders 2005., 5
• [5]Epidemiology of Diabetes Interventions and Complications (EDIC): Design, implementation, and preliminary results of a long-term follow-up of the Diabetes Control and Complications Trial cohort. Diabetes Care 1999, 22:99-111.
• [6]Cryer PE: Hypoglycemia-associated autonomic failure in diabetes. Am J Physiol Endocrinol Metab 2001, 281:E1115-E1121.
• [7]Zammitt NN, Frier BM: Hypoglycemia in type 2 diabetes: pathophysiology, frequency, and effects of different treatment modalities. Diabetes Care 2005, 28:2948-2961.
• [8]Henderson JN, Allen KV, Deary IJ, et al.: Hypoglycaemia in insulin-treated Type 2 diabetes: frequency, symptoms and impaired awareness. Diabet Med 2003, 20:1016-1021.
• [9]Donnelly LA, Morris AD, Frier BM, et al.: Frequency and predictors of hypoglycaemia in Type 1 and insulin-treated Type 2 diabetes: a population-based study. Diabet Med 2005, 22:749-755.
• [10]Control D, Group CTR: Adverse events and their association with treatment regimens in the Diabetes Control and Complications Trial. Diabetes Care 1995, 18:1415-1427.
• [11]Cryer PE, Axelrod L, Grossman AB, et al.: Evaluation and management of adult hypoglycemic disorders: an Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab 2009, 94:709-728.
• [12]Cryer PE: Diverse causes of hypoglycemia-associated autonomic failure in diabetes. N Engl J Med 2004, 350:2272-2279.
• [13]Gabriely I, Shamoon H: Hypoglycemia in diabetes: common, often unrecognized. Cleve Clin J Med 2004, 71:335-342.
• [14]UK Hypoglycaemia Study Group: Risk of hypoglycaemia in types 1 and 2 diabetes: effects of treatment modalities and their duration. Diabetologia 2007, 50:1140-1147.
• [15]Gerstein HC, Miller ME, Byington RP, et al.: Effects of intensive glucose lowering in type 2 diabetes. N Engl J Med 2008, 358:2545-2559.
• [16]Cryer PE: Hypoglycemia, functional brain failure, and brain death. J Clin Invest 2007, 117:868-870.
• [17]Cryer PE: Insulin Therapy and Hypoglycemia in Type 2 Diabetes Mellitus. Insulin 2007, 2:127-133.
• [18]Bakatselos SO: Hypoglycemia unawareness. Diabetes Res Clin Pract 2011, 93(Suppl 1):S92-S96.
• [19]Bolli GB, De Feo P, De Cosmo S, et al.: A reliable and reproducible test for adequate glucose counterregulation in type I diabetes mellitus. Diabetes 1984, 33:732-737.
• [20]Gold AE, MacLeod KM, Frier BM: Frequency of severe hypoglycemia in patients with type I diabetes with impaired awareness of hypoglycemia. Diabetes Care 1994, 17:697-703.
• [21]Dagogo-Jack SE, Craft S, Cryer PE: Hypoglycemia-associated autonomic failure in insulin-dependent diabetes mellitus. Recent antecedent hypoglycemia reduces autonomic responses to, symptoms of, and defense against subsequent hypoglycemia. J Clin Invest 1993, 91:819-828.
• [22]Davis SN, Mann S, Briscoe VJ, et al.: Effects of intensive therapy and antecedent hypoglycemia on counterregulatory responses to hypoglycemia in type 2 diabetes. Diabetes 2009, 58:701-709.
• [23]Malouf R, Brust JC: Hypoglycemia: causes, neurological manifestations, and outcome. Ann Neurol 1985, 17:421-430.
• [24]Stahl M, Berger W: Higher incidence of severe hypoglycaemia leading to hospital admission in Type 2 diabetic patients treated with long-acting versus short-acting sulphonylureas. Diabet Med 1999, 16:586-590.
• [25]Holstein A, Egberts EH: Risk of hypoglycaemia with oral antidiabetic agents in patients with Type 2 diabetes. Exp Clin Endocrinol Diabetes 2003, 111:405-414.
• [26]Holstein A, Plaschke A, Egberts EH: Clinical characterisation of severe hypoglycaemia–a prospective population-based study. Exp Clin Endocrinol Diabetes 2003, 111:364-369.
• [27]Heller S, Damm P, Mersebach H, et al.: Hypoglycemia in type 1 diabetic pregnancy: role of preconception insulin aspart treatment in a randomized study. Diabetes Care 2010, 33:473-477.
• [28]Evers IM, ter Braak EW, de Valk HW, et al.: Risk indicators predictive for severe hypoglycemia during the first trimester of type 1 diabetic pregnancy. Diabetes Care 2002, 25:554-559.
• [29]Nielsen LR, Pedersen-Bjergaard U, Thorsteinsson B, et al.: Hypoglycemia in pregnant women with type 1 diabetes: predictors and role of metabolic control. Diabetes Care 2008, 31:9-14.
• [30]Robertson H, Pearson DW, Gold AE: Severe hypoglycaemia during pregnancy in women with Type 1 diabetes is common and planning pregnancy does not decrease the risk. Diabet Med 2009, 26:824-826.
• [31]Rossi G, Lapaczewski P, Diamond MP, et al.: Inhibitory effect of pregnancy on counterregulatory hormone responses to hypoglycemia in awake rat. Diabetes 1993, 42:1440-1445.
• [32]Rosenn BM, Miodovnik M, Khoury JC, et al.: Counterregulatory hormonal responses to hypoglycemia during pregnancy. Obstet Gynecol 1996, 87:568-574.
• [33]Alagiakrishnan K, Mereu L: Approach to managing hypoglycemia in elderly patients with diabetes. Postgrad Med 2010, 122:129-137.
• [34]Avila-Fematt FM, Montana-Alvarez M: Hypoglycemia in the elderly with diabetes mellitus. Rev Invest Clin 62:366-374.
• [35]Bree AJ, Puente EC, Daphna-Iken D, et al.: Diabetes increases brain damage caused by severe hypoglycemia. Am J Physiol Endocrinol Metab 2009, 297:E194-E201.
• [36]Abbaszadeh Ahranjani S, Tabatabaei-Malazy O, Pajouhi M: Diabetes in old age, a review. Journal of Diabetes and Metabolic Disorders (Formerly: Iranian Journal of Diabetes and Lipid Disorders) 2009, 8:113-128.
• [37]Davis RE, Morrissey M, Peters JR, et al.: Impact of hypoglycaemia on quality of life and productivity in type 1 and type 2 diabetes. Curr Med Res Opin 2005, 21:1477-1483.
• [38]Bulsara MK, Holman CD, Davis EA, et al.: The impact of a decade of changing treatment on rates of severe hypoglycemia in a population-based cohort of children with type 1 diabetes. Diabetes Care 2004, 27:2293-2298.
• [39]Ly TT, Gallego PH, Davis EA, et al.: Impaired awareness of hypoglycemia in a population-based sample of children and adolescents with type 1 diabetes. Diabetes Care 2009, 32:1802-1806.
• [40]Northam EA, Anderson PJ, Jacobs R, et al.: Neuropsychological profiles of children with type 1 diabetes 6 years after disease onset. Diabetes Care 2001, 24:1541-1546.
• [41]Ho MS, Weller NJ, Ives FJ, et al.: Prevalence of structural central nervous system abnormalities in early-onset type 1 diabetes mellitus. J Pediatr 2008, 153:385-390.
• [42]Desouza C, Salazar H, Cheong B, et al.: Association of hypoglycemia and cardiac ischemia: a study based on continuous monitoring. Diabetes Care 2003, 26:1485-1489.
• [43]Wei M, Gibbons LW, Mitchell TL, et al.: Low fasting plasma glucose level as a predictor of cardiovascular disease and all-cause mortality. Circulation 2000, 101:2047-2052.
• [44]Hanssen KF, Dahl-Jorgensen K, Lauritzen T, et al.: Diabetic control and microvascular complications: the near-normoglycaemic experience. Diabetologia 1986, 29:677-684.
• [45]Duckworth W, Abraira C, Moritz T, et al.: Glucose control and vascular complications in veterans with type 2 diabetes. N Engl J Med 2009, 360:129-139.
• [46]Gimenez M, Gilabert R, Monteagudo J, et al.: Repeated episodes of hypoglycemia as a potential aggravating factor for preclinical atherosclerosis in subjects with type 1 diabetes. Diabetes Care 34:198-203.
• [47]Gogitidze Joy N, Hedrington MS, Briscoe VJ, et al.: Effects of acute hypoglycemia on inflammatory and pro-atherothrombotic biomarkers in individuals with type 1 diabetes and healthy individuals. Diabetes Care 2010, 33:1529-1535.
• [48]Wright RJ, Newby DE, Stirling D, et al.: Effects of acute insulin-induced hypoglycemia on indices of inflammation: putative mechanism for aggravating vascular disease in diabetes. Diabetes Care 2010, 33:1591-1597.
• [49]Wright RJ, Frier BM: Vascular disease and diabetes: is hypoglycaemia an aggravating factor? Diabetes Metab Res Rev 2008, 24:353-363.
• [50]Hadaegh F, Shafiee G, Ghasemi A, et al.: Impact of metabolic syndrome, diabetes and prediabetes on cardiovascular events: Tehran lipid and glucose study. Diabetes Res Clin Pract 87:342-347.
• [51]Frier BM, Hilsted J: Does hypoglycaemia aggravate the complications of diabetes? Lancet 1985, 2:1175-1177.
• [52]Robinson RT, Harris ND, Ireland RH, et al.: Changes in cardiac repolarization during clinical episodes of nocturnal hypoglycaemia in adults with Type 1 diabetes. Diabetologia 2004, 47:312-315.
• [53]Asvold BO, Sand T, Hestad K, et al.: Cognitive function in type 1 diabetic adults with early exposure to severe hypoglycemia: a 16-year follow-up study. Diabetes Care 2010, 33:1945-1947.
• [54]Ryan CM: Why is cognitive dysfunction associated with the development of diabetes early in life? The diathesis hypothesis. Pediatr Diabetes 2006, 7:289-297.
• [55]Chugani HT: A critical period of brain development: studies of cerebral glucose utilization with PET. Prev Med 1998, 27:184-188.
• [56]Huttenlocher PR: Morphometric study of human cerebral cortex development. Neuropsychologia 1990, 28:517-527.
• [57]Gaudieri PA, Chen R, Greer TF, et al.: Cognitive function in children with type 1 diabetes: a meta-analysis. Diabetes Care 2008, 31:1892-1897.
• [58]Whitmer RA, Karter AJ, Yaffe K, et al.: Hypoglycemic episodes and risk of dementia in older patients with type 2 diabetes mellitus. JAMA 2009, 301:1565-1572.
• [59]Rohling ML, Faust ME, Beverly B, et al.: Effectiveness of cognitive rehabilitation following acquired brain injury: a meta-analytic re-examination of Cicerone et al'.s (2000, 2005) systematic reviews. Neuropsychology 2009, 23:20-39.
• [60]Williams SA, Pollack MF, Dibonaventura M: Effects of hypoglycemia on health-related quality of life, treatment satisfaction and healthcare resource utilization in patients with type 2 diabetes mellitus. Diabetes Res Clin Pract 2010, 91:363-370.
• [61]Lundkvist J, Berne C, Bolinder B, et al.: The economic and quality of life impact of hypoglycemia. Eur J Health Econ 2005, 6:197-202.
• [62]Marrett E, Radican L, Davies MJ, et al.: Assessment of severity and frequency of selfreported hypoglycemia on quality of life in patients with type 2 diabetes treated with oral antihyperglycemic agents: A survey study. BMC Res Notes 2011, 4:251. BioMed Central Full Text
• [63]Kuo S, Fleming BB, Gittings NS, et al.: Trends in care practices and outcomes among Medicare beneficiaries with diabetes. Am J Prev Med 2005, 29:396-403.
• [64]Cryer PE, Childs BP: Negotiating the barrier of hypoglycemia in diabetes. Diabetes Spectrum 2002, 15:20.
• [65]Cryer PE, Davis SN, Shamoon H: Hypoglycemia in diabetes. Diabetes Care 2003, 26:1902-1912.
• [66]Mensing C, Boucher J, Cypress M, et al.: National standards for diabetes selfmanagement education. Diabetes Care 2006, 29(Suppl 1):S78-S85.
• [67]Tol A, Mohajeri Tehrani MR, Mahmoodi G, Alhani F, Shojaeezadeh D, Eslami A, Sharifirad G: Development of a Valid and Reliable Diabetes Self-management Instrument: An Iranian Version. Journal of Diabetes and Metabolic Disorders (Formerly: Iranian Journal of Diabetes and Lipid Disorders) 2011, 10:1-6.
• [68]Norris SL, Lau J, Smith SJ, et al.: Self-management education for adults with type 2 diabetes: a meta-analysis of the effect on glycemic control. Diabetes Care 2002, 25:1159-1171.
• [69]D'Eramo-Melkus GA, Wylie-Rosett J, Hagan JA: Metabolic impact of education in NIDDM. Diabetes Care 1992, 15:864-869.
• [70]Khamseh ME, Ansari M, Malek M, et al.: Effects of a structured self-monitoring of blood glucose method on patient self-management behavior and metabolic outcomes in type 2 diabetes mellitus. J Diabetes Sci Technol 2010, 5:388-393.
• [71]Boutati EI, Raptis SA: Self-monitoring of blood glucose as part of the integral care of type 2 diabetes. Diabetes Care 2009, 32(Suppl 2):S205-S210.
• [72]Wolpert HA: Use of continuous glucose monitoring in the detection and prevention of hypoglycemia. J Diabetes Sci Technol 2007, 1:146-150.
• [73]Briscoe VJ, Davis SN: Hypoglycemia in type 1 and type 2 diabetes: physiology, pathophysiology, and management. Clinical Diabetes 2006, 24:115-124.
• [74]Skyler JS, Ponder S, Kruger DF, et al.: Is there a place for insulin pump therapy in your practice? Clinical Diabetes 2007, 25:50-56.
• [75]Qaseem A, Vijan S, Snow V, et al.: Glycemic control and type 2 diabetes mellitus: the optimal hemoglobin A1c targets. A guidance statement from the American College of Physicians. Ann Intern Med 2007, 147:417-422.
• [76]Standards of medical care in diabetes--2009 Diabetes Care 2009, 32(Suppl 1):S13-S61.
• [77]Gary TL, Batts-Turner M, Yeh HC, et al.: The effects of a nurse case manager and a community health worker team on diabetic control, emergency department visits, and hospitalizations among urban African Americans with type 2 diabetes mellitus: a randomized controlled trial. Arch Intern Med 2009, 169:1788-1794.
• [78]Brink SJ, Miller M, Moltz KC: Education and multidisciplinary team care concepts for pediatric and adolescent diabetes mellitus. J Pediatr Endocrinol Metab 2002, 15:1113-1130.