Evidence-informed clinical practice recommendations for treatment of type 1 diabetes complicated by problematic hypoglycemia

Pratik Choudhary, Michael R. Rickels, Peter A. Senior, Marie Christine Vantyghem, Paola Maffi, Thomas W. Kay, Bart Keymeulen, Nobuya Inagaki, Frantisek Saudek, Roger Lehmann, Bernhard J. Hering

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79 Citations (Scopus)

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 languageEnglish
Pages (from-to)1016-1029
Number of pages14
JournalDiabetes Care
Volume38
Issue number6
DOIs
Publication statusPublished - Jun 1 2015

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Type 1 Diabetes Mellitus
Hypoglycemia
Therapeutics
Transplants
Glucose
Insulin
Technology
Education
Subcutaneous Infusions
Fear
Pancreas

ASJC Scopus subject areas

  • Internal Medicine
  • Endocrinology, Diabetes and Metabolism
  • Advanced and Specialised Nursing
  • Medicine(all)

Cite this

Choudhary, P., Rickels, M. R., Senior, P. A., Vantyghem, M. C., Maffi, P., Kay, T. W., ... Hering, B. J. (2015). Evidence-informed clinical practice recommendations for treatment of type 1 diabetes complicated by problematic hypoglycemia. Diabetes Care, 38(6), 1016-1029. https://doi.org/10.2337/dc15-0090

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 journalArticle

Choudhary, P, Rickels, MR, Senior, PA, Vantyghem, MC, Maffi, P, Kay, TW, Keymeulen, B, Inagaki, N, Saudek, F, Lehmann, R & Hering, BJ 2015, 'Evidence-informed clinical practice recommendations for treatment of type 1 diabetes complicated by problematic hypoglycemia', Diabetes Care, vol. 38, no. 6, pp. 1016-1029. https://doi.org/10.2337/dc15-0090
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. / Evidence-informed clinical practice recommendations for treatment of type 1 diabetes complicated by problematic hypoglycemia. In: Diabetes Care. 2015 ; Vol. 38, No. 6. pp. 1016-1029.
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