Guidelines updated for managing diabetes with high risk for hypoglycemia
Click Here to Manage Email Alerts
The Endocrine Society released updated clinical practice guidelines that account for new technology and newer forms of insulin and glucagon in the management of diabetes-related hypoglycemia.
These recommendations, published in The Journal of Clinical Endocrinology & Metabolism, are updates from the Endocrine Society’s 2009 inpatient hypoglycemia guideline.
“[Continuous glucose monitoring] 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,” Anthony L. McCall, MD, PhD, research professor in the department of medicine in the division of endocrinology and metabolism at the University of Virginia Medical School, Charlottesville, said in a related press release. “People with diabetes, their caregivers and diabetes specialists will all benefit from our guideline with a better understanding of best practices and interventions.”
A multidisciplinary panel of clinician experts, patient representatives and methodologists identified and created 10 clinical questions related to individuals with diabetes who are at risk for hypoglycemia. Following systematic reviews, the panel agreed on recommendations specific to hypoglycemia risk and prevention for individuals with diabetes.
These updated recommendations include the following:
- Use CGM instead of self-monitoring of blood glucose by finger stick for people with type 1 diabetes receiving multiple daily injections.
- Use real-time CGM and algorithm-driven insulin pumps rather than multiple daily injections with self-monitoring of blood glucose three or more times per day for individuals with type 1 diabetes.
- Use real-time CGM instead of no CGM for outpatients with type 2 diabetes who take insulin and/or sulfonylureas and are at risk for hypoglycemia.
- Initiate CGM in the inpatient setting for people at high risk for hypoglycemia.
- Continue personal CGM in the inpatient setting with or without algorithm-driven insulin pump therapy.
- Use inpatient glycemic surveillance and management programs using electronic health records for inpatients at risk for hypoglycemia.
- Use long-acting insulin analogs for outpatients on basal insulin therapy at high risk for hypoglycemia.
- Use rapid-acting insulin analogs for individuals on basal-bolus insulin therapy at high risk for hypoglycemia.
- Use a structured program of patient education for outpatients with type 1 or type 2 diabetes receiving insulin therapy.
- Use glucagon preparations that do not have to be reconstituted for outpatients with severe hypoglycemia.
“The importance of treating acute severe hypoglycemia with glucagon emphasizes the need for further research,” the authors wrote. “A proposed area for future research is analyzing how often new glucagon preparations are used and their effect on resource utilization.”
Reference:
- New Endocrine Society Clinical Practice Guideline examines better ways to manage hypoglycemia in people with diabetes. Published Dec. 7, 2022. Accessed Dec. 7, 2022.
Collapse
Read more about
Click Here to Manage Email Alerts