Abstract
Problematic hypoglycemia, defined as two or more episodes per year of severe hypoglycemia or as one episode associated with impaired awareness of hypoglycemia, extreme glycemic lability, ormajor fear andmaladaptive behavior, is a challenge, especially for patients with long-standing type 1 diabetes. Individualized therapy for such patients should include a composite target: optimal glucose control without problematic hypoglycemia. Therefore, we propose a tiered, four-stage algorithm based on evidence of efficacy given the limitations of educational, technological, and transplant interventions. All patientswith problematic hypoglycemia should undergo structured or hypoglycemia-specific education programs (stage 1). Glycemic and hypoglycemia treatment targets should be individualized and reassessed every 3-6 months. If targets are not met, one diabetes technologydcontinuous subcutaneous insulin infusion or continuous glucose monitoringdshould be added (stage 2). For patients with continued problematic hypoglycemia despite education (stage 1) and one diabetes technology (stage 2), sensor-augmented insulin pumps preferably with an automated low-glucose suspend feature and/or very frequent contact with a specialized hypoglycemia service can reduce hypoglycemia (stage 3). For patients whose problematic hypoglycemia persists, islet or pancreas transplant should be considered (stage 4). This algorithm provides an evidence-informed approach to resolving problematic hypoglycemia; it should be used as a guide, with individual patient circumstances directing suitability and acceptability to ensure the prudent use of technology and scarce transplant resources. Standardized reporting of hypoglycemia outcomes and inclusion of patients with problematic hypoglycemia in studies of new interventions may help to guide future therapeutic strategies.
| Original language | English |
|---|---|
| Pages (from-to) | 1016-1029 |
| Number of pages | 14 |
| Journal | Diabetes Care |
| Volume | 38 |
| Issue number | 6 |
| DOIs | |
| Publication status | Published - Jun 1 2015 |
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ASJC Scopus subject areas
- Internal Medicine
- Endocrinology, Diabetes and Metabolism
- Advanced and Specialised Nursing
- Medicine(all)
Cite this
Evidence-informed clinical practice recommendations for treatment of type 1 diabetes complicated by problematic hypoglycemia. / Choudhary, Pratik; Rickels, Michael R.; Senior, Peter A.; Vantyghem, Marie Christine; Maffi, Paola; Kay, Thomas W.; Keymeulen, Bart; Inagaki, Nobuya; Saudek, Frantisek; Lehmann, Roger; Hering, Bernhard J.
In: Diabetes Care, Vol. 38, No. 6, 01.06.2015, p. 1016-1029.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Evidence-informed clinical practice recommendations for treatment of type 1 diabetes complicated by problematic hypoglycemia
AU - Choudhary, Pratik
AU - Rickels, Michael R.
AU - Senior, Peter A.
AU - Vantyghem, Marie Christine
AU - Maffi, Paola
AU - Kay, Thomas W.
AU - Keymeulen, Bart
AU - Inagaki, Nobuya
AU - Saudek, Frantisek
AU - Lehmann, Roger
AU - Hering, Bernhard J.
PY - 2015/6/1
Y1 - 2015/6/1
N2 - Problematic hypoglycemia, defined as two or more episodes per year of severe hypoglycemia or as one episode associated with impaired awareness of hypoglycemia, extreme glycemic lability, ormajor fear andmaladaptive behavior, is a challenge, especially for patients with long-standing type 1 diabetes. Individualized therapy for such patients should include a composite target: optimal glucose control without problematic hypoglycemia. Therefore, we propose a tiered, four-stage algorithm based on evidence of efficacy given the limitations of educational, technological, and transplant interventions. All patientswith problematic hypoglycemia should undergo structured or hypoglycemia-specific education programs (stage 1). Glycemic and hypoglycemia treatment targets should be individualized and reassessed every 3-6 months. If targets are not met, one diabetes technologydcontinuous subcutaneous insulin infusion or continuous glucose monitoringdshould be added (stage 2). For patients with continued problematic hypoglycemia despite education (stage 1) and one diabetes technology (stage 2), sensor-augmented insulin pumps preferably with an automated low-glucose suspend feature and/or very frequent contact with a specialized hypoglycemia service can reduce hypoglycemia (stage 3). For patients whose problematic hypoglycemia persists, islet or pancreas transplant should be considered (stage 4). This algorithm provides an evidence-informed approach to resolving problematic hypoglycemia; it should be used as a guide, with individual patient circumstances directing suitability and acceptability to ensure the prudent use of technology and scarce transplant resources. Standardized reporting of hypoglycemia outcomes and inclusion of patients with problematic hypoglycemia in studies of new interventions may help to guide future therapeutic strategies.
AB - Problematic hypoglycemia, defined as two or more episodes per year of severe hypoglycemia or as one episode associated with impaired awareness of hypoglycemia, extreme glycemic lability, ormajor fear andmaladaptive behavior, is a challenge, especially for patients with long-standing type 1 diabetes. Individualized therapy for such patients should include a composite target: optimal glucose control without problematic hypoglycemia. Therefore, we propose a tiered, four-stage algorithm based on evidence of efficacy given the limitations of educational, technological, and transplant interventions. All patientswith problematic hypoglycemia should undergo structured or hypoglycemia-specific education programs (stage 1). Glycemic and hypoglycemia treatment targets should be individualized and reassessed every 3-6 months. If targets are not met, one diabetes technologydcontinuous subcutaneous insulin infusion or continuous glucose monitoringdshould be added (stage 2). For patients with continued problematic hypoglycemia despite education (stage 1) and one diabetes technology (stage 2), sensor-augmented insulin pumps preferably with an automated low-glucose suspend feature and/or very frequent contact with a specialized hypoglycemia service can reduce hypoglycemia (stage 3). For patients whose problematic hypoglycemia persists, islet or pancreas transplant should be considered (stage 4). This algorithm provides an evidence-informed approach to resolving problematic hypoglycemia; it should be used as a guide, with individual patient circumstances directing suitability and acceptability to ensure the prudent use of technology and scarce transplant resources. Standardized reporting of hypoglycemia outcomes and inclusion of patients with problematic hypoglycemia in studies of new interventions may help to guide future therapeutic strategies.
UR - http://www.scopus.com/inward/record.url?scp=84962438836&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84962438836&partnerID=8YFLogxK
U2 - 10.2337/dc15-0090
DO - 10.2337/dc15-0090
M3 - Article
C2 - 25998294
AN - SCOPUS:84962438836
VL - 38
SP - 1016
EP - 1029
JO - Diabetes Care
JF - Diabetes Care
SN - 1935-5548
IS - 6
ER -