The following is a summary of “A Systematic Review Supporting the Endocrine Society Guidelines: Management of Diabetes and High Risk of Hypoglycemia,” published in the March 2023 issue of Endocrinology & Metabolism by Roldan, et al.

Interventions aimed at preventing hypoglycemia were crucial for improving the well-being of individuals with diabetes and reducing their risk of morbidity and mortality. 

To assist the Endocrine Society in developing clinical practice guidelines for managing people with diabetes at high risk for hypoglycemia, researchers systematically reviewed the literature using several databases and the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology to assess the certainty of evidence.

The study included 149 studies covering 43,344 patients. They found that continuous glucose monitoring (CGM) reduced the frequency of severe hypoglycemic episodes in patients with type 1 diabetes (T1D) and decreased the proportion of patients experiencing hypoglycemia (blood glucose [BG] levels <54 mg/dL). However, no data were comparing real-time CGM with algorithm-driven insulin pumps to multiple daily injections with BG testing in people with T1D. In outpatients with type 2 diabetes taking insulin and/or sulfonylureas, CGM reduced the time spent with BG levels under 70 mg/dL. Similarly, initiation of CGM in hospitalized patients at high risk for hypoglycemia reduced episodes of hypoglycemia and time spent under 54 mg/dL. However, the proportion of patients with hypoglycemia detected by CGM was significantly higher than in point-of-care BG testing.

They also found that using an inpatient computerized glycemic management program utilizing electronic health record data reduced the incidence of hypoglycemia compared to standard care. Less hypoglycemia was linked to long-acting basal insulin analogs. Rapid-acting insulin analogs were linked to reduced severe hypoglycemia, even though patients with mild to moderate hypoglycemia were more prevalent. Organized diabetes education programs decreased the episodes of severe hypoglycemia and the duration below 54 mg/dL in insulin-using outpatients. Even though the percentage of patients who fully recovered from hypoglycemia was comparable between the 2 groups, glucagon formulations that did not require reconstitution were linked to longer recovery durations.

In summary, the study provided valuable evidence on the effectiveness of various interventions for preventing hypoglycemia in people with diabetes. In addition, the evidence base will aid the Endocrine Society in developing clinical practice guidelines for managing individuals with diabetes at high risk for hypoglycemia.

Reference: academic.oup.com/jcem/article/108/3/592/6880630