Generic placeholder image

Current Diabetes Reviews

Editor-in-Chief

ISSN (Print): 1573-3998
ISSN (Online): 1875-6417

Mini-Review Article

Burden and Coping Strategies of Hypoglycemia in People with Diabetes

Author(s): Aris Liakos*, Thomas Karagiannis, Ioannis Avgerinos, Apostolos Tsapas and Eleni Bekiari

Volume 20, Issue 6, 2024

Published on: 20 October, 2023

Article ID: e201023222415 Pages: 7

DOI: 10.2174/0115733998271244231010100747

Price: $65

Abstract

Hypoglycemia is a limiting adverse effect of glucose-lowering medications and particularly insulin replacement therapy. This review provides insights into the burden of hypoglycemia in the management of diabetes and outlines strategies available to reduce the risk of hypoglycemia and improve patients’ well-being. People with type 1 diabetes are primarily affected by hypoglycemic episodes which are associated with direct physical harms like injuries and cardiac events as well as indirect psychosocial consequences including constant anxiety, absenteeism, increased healthcare costs and overall poorer quality of life. These complications are more prominent amongst individuals with hypoglycemia unawareness or overnight hypoglycemia and could even extend to caregivers such as parents of children with diabetes. Patients experiencing frequent or severe hypoglycemic events might also develop a pathological fear of hypoglycemia and adopt aberrant behaviors intending to maintain higher blood glucose levels. Modern pharmaceutical options with a safer profile in terms of hypoglycemia are available including novel basal insulins with lower rates of nocturnal hypoglycemia along with ultra-rapid-acting insulin analogs with a shorter duration of action that might avert late post-meal hypoglycemia. Continuous glucose monitoring and sensor-augmented insulin pump therapy with low glucose suspend technology can also prevent hypoglycemia, although concerns about cost and patient satisfaction remain. Advancements in insulin therapy and technological modalities should be coupled with ongoing education and support for patients to become co-managers of their disease and reduce the risk of hypoglycemia.

Keywords: Hypoglycemia, insulin therapy, fear of hypoglycemia, diabetes distress, hypoglycemia unawareness, diabetesrelated quality of life.

[1]
Marinac M, Sutphin J, Hutton C, Klein K, Sullivan S, Mansfield C. Preferences for outcomes among adults with type 1 diabetes and caregivers of children with type 1 diabetes. Patient Prefer Adherence 2020; 14: 1719-31.
[http://dx.doi.org/10.2147/PPA.S262358] [PMID: 33061315]
[2]
Przezak A, Bielka W. Molęda P. Fear of hypoglycemia—An underestimated problem. Brain Behav 2022; 12(7): e2633.
[http://dx.doi.org/10.1002/brb3.2633] [PMID: 35620854]
[3]
Agiostratidou G, Anhalt H, Ball D, et al. Standardizing clinically meaningful outcome measures beyond HbA1c for type 1 diabetes: A consensus report of the American Association of Clinical Endocrinologists, the American Association of Diabetes Educators, the American Diabetes Association, the Endocrine Society, JDRF International, The Leona M. and Harry B. Helmsley Charitable Trust, the Pediatric Endocrine Society, and the T1D Exchange. Diabetes Care 2017; 40(12): 1622-30.
[http://dx.doi.org/10.2337/dc17-1624] [PMID: 29162582]
[4]
Battelino T, Danne T, Bergenstal RM, et al. Clinical targets for continuous glucose monitoring data interpretation: recommendations from the International Consensus on Time in Range. Diabetes Care 2019; 42(8): 1593-603.
[http://dx.doi.org/10.2337/dci19-0028] [PMID: 31177185]
[5]
Danne T, Nimri R, Battelino T, et al. International consensus on use of continuous glucose monitoring. Diabetes Care 2017; 40(12): 1631-40.
[http://dx.doi.org/10.2337/dc17-1600] [PMID: 29162583]
[6]
The Diabetes Control and Complications Trial Research Group. Hypoglycemia in the diabetes control and complications trial. Diabetes 1997; 46(2): 271-86.
[http://dx.doi.org/10.2337/diab.46.2.271] [PMID: 9000705]
[7]
Nielsen LR, Pedersen-Bjergaard U, Thorsteinsson B, Johansen M, Damm P, Mathiesen ER. Hypoglycemia in pregnant women with type 1 diabetes: predictors and role of metabolic control. Diabetes Care 2008; 31(1): 9-14.
[http://dx.doi.org/10.2337/dc07-1066] [PMID: 17909091]
[8]
Gerstein HC, Miller ME, Byington RP, et al. Effects of intensive glucose lowering in type 2 diabetes. N Engl J Med 2008; 358(24): 2545-59.
[http://dx.doi.org/10.1056/NEJMoa0802743] [PMID: 18539917]
[9]
McAulay V, Deary IJ, Frier BM. Symptoms of hypoglycaemia in people with diabetes. Diabet Med 2001; 18(9): 690-705.
[http://dx.doi.org/10.1046/j.1464-5491.2001.00620.x] [PMID: 11606166]
[10]
Johnston SS, Conner C, Aagren M, Smith DM, Bouchard J, Brett J. Evidence linking hypoglycemic events to an increased risk of acute cardiovascular events in patients with type 2 diabetes. Diabetes Care 2011; 34(5): 1164-70.
[http://dx.doi.org/10.2337/dc10-1915] [PMID: 21421802]
[11]
Cryer PE. Mechanisms of hypoglycemia-associated autonomic failure in diabetes. N Engl J Med 2013; 369(4): 362-72.
[http://dx.doi.org/10.1056/NEJMra1215228] [PMID: 23883381]
[12]
Berry E, Lockhart S, Davies M, Lindsay JR, Dempster M. Diabetes distress: Understanding the hidden struggles of living with diabetes and exploring intervention strategies. Postgrad Med J 2015; 91(1075): 278-83.
[http://dx.doi.org/10.1136/postgradmedj-2014-133017] [PMID: 25827438]
[13]
Gonder-Frederick LA, Schmidt KM, Vajda KA, et al. Psychometric properties of the hypoglycemia fear survey-ii for adults with type 1 diabetes. Diabetes Care 2011; 34(4): 801-6.
[http://dx.doi.org/10.2337/dc10-1343] [PMID: 21346182]
[14]
Kuniss N, Freyer M, Müller N, Kielstein V, Müller UA. Expectations and fear of diabetes-related long-term complications in people with type 2 diabetes at primary care level. Acta Diabetol 2019; 56(1): 33-8.
[http://dx.doi.org/10.1007/s00592-018-1217-9] [PMID: 30159745]
[15]
Evans M, Khunti K, Mamdani M, et al. Health-related quality of life associated with daytime and nocturnal hypoglycaemic events: a time trade-off survey in five countries. Health Qual Life Outcomes 2013; 11(1): 90.
[http://dx.doi.org/10.1186/1477-7525-11-90] [PMID: 23731777]
[16]
Fidler C, Elmelund Christensen T, Gillard S. Hypoglycemia: An overview of fear of hypoglycemia, quality-of-life, and impact on costs. J Med Econ 2011; 14(5): 646-55.
[http://dx.doi.org/10.3111/13696998.2011.610852] [PMID: 21854191]
[17]
Yaffe K, Falvey CM, Hamilton N, et al. Association between hypoglycemia and dementia in a biracial cohort of older adults with diabetes mellitus. JAMA Intern Med 2013; 173(14): 1300-6.
[http://dx.doi.org/10.1001/jamainternmed.2013.6176] [PMID: 23753199]
[18]
Kosachunhanun N, Wongsa D, Permsuwan U. Economic burdens of type 2 diabetes hospital visits with hypoglycemic episodes in the tertiary care setting in Thailand. Healthcare (Basel) 2023; 11(7): 949.
[http://dx.doi.org/10.3390/healthcare11070949] [PMID: 37046876]
[19]
Giorda CB, Rossi MC, Ozzello O, et al. Healthcare resource use, direct and indirect costs of hypoglycemia in type 1 and type 2 diabetes, and nationwide projections. Results of the HYPOS-1 study. Nutr Metab Cardiovasc Dis 2017; 27(3): 209-16.
[http://dx.doi.org/10.1016/j.numecd.2016.10.005] [PMID: 28017523]
[20]
Iqbal A, Heller SR. The role of structured education in the management of hypoglycaemia. Diabetologia 2018; 61(4): 751-60.
[http://dx.doi.org/10.1007/s00125-017-4334-z] [PMID: 28660491]
[21]
Bott S, Bott U, Berger M, Mühlhauser I. Intensified insulin therapy and the risk of severe hypoglycaemia. Diabetologia 1997; 40(8): 926-32.
[http://dx.doi.org/10.1007/s001250050769] [PMID: 9267987]
[22]
Hopkins D, Lawrence I, Mansell P, et al. Improved biomedical and psychological outcomes 1 year after structured education in flexible insulin therapy for people with type 1 diabetes: The U.K. DAFNE experience. Diabetes Care 2012; 35(8): 1638-42.
[http://dx.doi.org/10.2337/dc11-1579] [PMID: 22619082]
[23]
Little SA, Leelarathna L, Walkinshaw E, et al. Recovery of hypoglycemia awareness in long-standing type 1 diabetes: A multicenter 2 × 2 factorial randomized controlled trial comparing insulin pump with multiple daily injections and continuous with conventional glucose self-monitoring (HypoCOMPaSS). Diabetes Care 2014; 37(8): 2114-22.
[http://dx.doi.org/10.2337/dc14-0030] [PMID: 24854041]
[24]
Kinsley BT, Weinger K, Bajaj M, et al. Blood glucose awareness training and epinephrine responses to hypoglycemia during intensive treatment in type 1 diabetes. Diabetes Care 1999; 22(7): 1022-8.
[http://dx.doi.org/10.2337/diacare.22.7.1022] [PMID: 10388961]
[25]
Cox DJ, Kovatchev B, Kovatchev B, et al. Hypoglycemia anticipation, awareness and treatment training (HAATT) reduces occurrence of severe hypoglycemia among adults with type 1 diabetes mellitus. Int J Behav Med 2004; 11(4): 212-8.
[http://dx.doi.org/10.1207/s15327558ijbm1104_4] [PMID: 15657021]
[26]
Hermanns N, Kulzer B, Kubiak T, Krichbaum M, Haak T. The effect of an education programme (HyPOS) to treat hypoglycaemia problems in patients with type 1 diabetes. Diabetes Metab Res Rev 2007; 23(7): 528-38.
[http://dx.doi.org/10.1002/dmrr.710] [PMID: 17245692]
[27]
Patton SR, Clements MA, Marker AM, Nelson EL. Intervention to reduce hypoglycemia fear in parents of young kids using video‐based telehealth (REDCHiP). Pediatr Diabetes 2020; 21(1): 112-9.
[http://dx.doi.org/10.1111/pedi.12934] [PMID: 31610073]
[28]
Cowart K, Franks R, Pane O, Murphy E, Oldziej K. Addressing overbasalization to achieve glycemic targets. ADCES in Practice 2022; 10(2): 30-5.
[http://dx.doi.org/10.1177/2633559X211068884]
[29]
Madenidou AV, Paschos P, Karagiannis T, et al. Comparative benefits and harms of basal insulin analogues for type 2 diabetes: A systematic review and network meta-analysis. Ann Intern Med 2018; 169(3): 165-74.
[http://dx.doi.org/10.7326/M18-0443] [PMID: 29987326]
[30]
Wong EY, Kroon L. Ultra-rapid-acting insulins: How fast is really needed? Clin Diabetes 2021; 39(4): 415-23.
[http://dx.doi.org/10.2337/cd20-0119] [PMID: 34866783]
[31]
Avgerinos I, Papanastasiou G, Karagiannis T, et al. Ultra‐rapid‐acting insulins for adults with diabetes: A systematic review and meta‐analysis. Diabetes Obes Metab 2021; 23(10): 2395-401.
[http://dx.doi.org/10.1111/dom.14461] [PMID: 34105242]
[32]
Silva RR, Gauza MM, Guisso MES, Silva JON, Kohara SK. Once-weekly insulin icodec vs. Once-daily insulin glargine U100 for type 2 diabetes: A systematic review and meta-analysis of phase 2 randomized controlled trials. Arch Endocrinol Metab 2023; 67(5): e000614.
[http://dx.doi.org/10.20945/2359-3997000000614] [PMID: 37249450]
[33]
Davies MJ, Aroda VR, Collins BS, et al. Management of hyperglycemia in type 2 diabetes, 2022. A consensus report by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD). Diabetes Care 2022; 45(11): 2753-86.
[http://dx.doi.org/10.2337/dci22-0034] [PMID: 36148880]
[34]
Liakopoulou P, Liakos A, Vasilakou D, et al. Fixed ratio combinations of glucagon like peptide 1 receptor agonists with basal insulin: A systematic review and meta-analysis. Endocrine 2017; 56(3): 485-94.
[http://dx.doi.org/10.1007/s12020-017-1293-6] [PMID: 28401444]
[35]
Pontiroli AE, Tagliabue E. Intranasal versus injectable glucagon for hypoglycemia in type 1 diabetes: Systematic review and meta-analysis. Acta Diabetol 2020; 57(6): 743-9.
[http://dx.doi.org/10.1007/s00592-020-01483-y] [PMID: 32025860]
[36]
van Beers CAJ, DeVries JH. Continuous glucose monitoring: Impact on hypoglycemia. J Diabetes Sci Technol 2016; 10(6): 1251-8.
[http://dx.doi.org/10.1177/1932296816653411] [PMID: 27257169]
[37]
Bekiari E, Kitsios K, Thabit H, et al. Artificial pancreas treatment for outpatients with type 1 diabetes: Systematic review and meta-analysis. BMJ 2018; 361: k1310.
[http://dx.doi.org/10.1136/bmj.k1310] [PMID: 29669716]
[38]
Dutta D, Mohindra R, Mahajan K, Sharma M. Performance of fast-acting aspart insulin as compared to aspart insulin in insulin pump for managing type 1 diabetes mellitus: a meta-analysis. Diabetes Metab J 2023; 47(1): 72-81.
[http://dx.doi.org/10.4093/dmj.2022.0035] [PMID: 35746893]
[39]
Khunti K, Alsifri S, Aronson R, et al. Rates and predictors of hypoglycaemia in 27 585 people from 24 countries with insulin‐treated type 1 and type 2 diabetes: the global HAT study. Diabetes Obes Metab 2016; 18(9): 907-15.
[http://dx.doi.org/10.1111/dom.12689] [PMID: 27161418]

Rights & Permissions Print Cite
© 2024 Bentham Science Publishers | Privacy Policy