The Endocrine Society outlined advances in medications and technologies to lower the risk of diabetes-related hypoglycemia in the newly released Clinical Practice Guideline titled Management of Individuals with Diabetes at High Risk for Hypoglycemia. The guideline incorporates recommendations to treat and manage diabetes-related hypoglycemia more effectively using new insulins and forms of glucagon, as well as advancements in continuous glucose monitoring (CGM) and insulin pump technology.

Hypoglycemia is among the top preventable adverse drug events and is a target of the National Action Plan for Adverse Drug Event Prevention by the US Department of Health and Human Services. Between January 2007 and December 2011, more than $600 million was spent on emergency department visits for therapy-associated hypoglycemia among Medicare beneficiaries.

This guideline updates the Society’s 2009 inpatient hypoglycemia guideline and focuses solely on people with diabetes-related hypoglycemia. “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,” said guideline chair Anthony L. McCall, MD, PhD, of the University of Virginia in Charlottesville, Va. “People with diabetes, their caregivers, and diabetes specialists will all benefit from our guideline with a better understanding of best practices and interventions.”


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Table. Key Recommendations From the Hypoglycemia Management Guidelines

Use glucagon preparations that do not require reconstitution for adults and children with severe outpatient hypoglycemia
Use real-time CGM rather than self-monitoring of blood glucose by fingerstick for patients with type 1 diabetes receiving multiple daily injections
Conduct inpatient glycemic surveillance and management programs leveraging electronic health record data for inpatients at risk for hypoglycemia
Use structured patient education programs for adult and pediatric patients with type 1 diabetes or type 2 diabetes receiving insulin therapy.
CGM, continuous glucose monitoring

The guideline was published online and will appear in the March 2023 print issue of The Journal of Clinical Endocrinology & Metabolism. The Endocrine Society also provides toolkits for providers and hypoglycemia patient resources.

Sources

New Endocrine Society Clinical Practice Guideline examines better ways to manage hypoglycemia in people with diabetes. News release. Endocrine Society; December 7, 2022. https://www.endocrine.org/news-and-advocacy/news-room/2022/new-endocrine-society-clinical-practice-guideline-examines-better-ways-to-manage-hypoglycemia

McCall AL, Lieb DC, Gianchandani R. Management of individuals with diabetes at high risk for hypoglycemia: an Endocrine Society Clinical Practice Guideline. J Clin Endo Metabolism. Published online December 7, 2022.