An Innovative Approach for Predicting Severe Hypoglycemia

The investigators in this trial have a long history in the study of hypoglycemia and in identifying methods for early detection and treatment. They previously demonstrated that the LBGI, a measure of the frequency and extent of low SMBG readings, accounts for as much as 40–55% of future SH episodes. Here, they nicely drew on their work with the LBGI and used it as a methodology in this study of SH.

Because SH can result in a number of debilitating outcomes such as cognitive dysfunction, accidents, seizures, coma, and death, it has been associated with patient fear and is identified as a barrier to glycemic control in diabetes. Strategies that offer patients an opportunity for early detection and immediate treatment have the potential to alleviate fears and this significant barrier to meeting treatment goals.

Determining ways to alleviate the risk of hypoglycemia is crucially important because the risk for hypoglycemia has been posed as one reason for clinical inertia (the failure to intensify diabetes management in a timely manner). The complexity of diabetes management requires health professionals to be able to support their patients with the appropriate amount of time, education, and long-term support strategies necessary for effective self-management. This is particularly true in areas related to treatment intensification and to identification and treatment of hypoglycemia.

The majority of patients with diabetes are seen in a primary care setting, which presents interesting challenges for the facilitation of intensified therapies. Team-based care has been shown to be the best predictor of improved glycemia. However, primary care practices are often ill-equipped to manage intensive regimens because they may not have the necessary access to team and support services.

The decision to delay therapy in many cases may be related to fears about inadequate educational resources and added workload. One can appreciate the reluctance of busy practitioners who avoid the potential for hypoglycemia in their patients, particularly in those who are vulnerable to SH.

Diabetes is a complex disease that requires patients to be knowledgeable and able to make daily decisions that affect their own health. Thus, the onus is on patients to be responsible for hypoglycemia management. The authors of this study present an evidence-based, practical hypoglycemia-prevention tool for clinicians and educators to use with their patients who are at high risk for SH.

Objective. Research demonstrates the importance of achieving near-normal glycemia in the prevention of diabetes-related complications.1 However, in an effort to attain euglycemia, one runs the risk for hypoglycemia.2 Severe hypoglycemia (SH), a low blood glucose resulting in stupor, seizure, or unconsciousness, prohibits self-treatment. To prevent SH, one must be able to anticipate when an event may occur to initiate treatment steps or identify warning signs and take action to stop further progression. The objective of this study was to test methods for predicting SH by using blood glucose meter readings.. One hundred adults with type 1 diabetes and 79 insulin-using adults with type 2 diabetes participated in this study. Their self-monitoring of blood glucose (SMBG) readings were stored on memory meters, and the patients were asked biweekly about the occurrence of SH.