Management of Individuals with Diabetes at High Risk for Hypoglycemia: An Endocrine Society Clinical Practice Guideline Activity-Clinical Practice Guideline: Management of Individuals With Diabetes at High Risk for Hypoglycemia

Clinical Practice Guideline: Management of Individuals With Diabetes at High Risk for Hypoglycemia

Pdf Summary

The Endocrine Society's Clinical Practice Guideline addresses the management of diabetes in individuals at high risk for hypoglycemia. This comprehensive guideline revises and updates the 2009 recommendations and introduces new insights and approaches for both adults and children living with diabetes. The guideline’s main objectives are to reduce and prevent hypoglycemia by providing practical, evidence-based recommendations.<br /><br />Key recommendations include:<br />1. Continuous glucose monitoring (CGM) is advised over self-monitoring of blood glucose (SMBG) for individuals with type 1 diabetes (T1D) using multiple daily injections (MDIs).<br />2. The combined use of real-time CGM and algorithm-driven insulin pumps (ADIPs) is recommended for T1D patients over using MDIs with SMBG.<br />3. For individuals with type 2 diabetes (T2D) who take insulin and/or sulfonylureas (SUs) and are at high risk for hypoglycemia, real-time CGM is suggested over no CGM.<br />4. Continuous glucose monitoring should be initiated in the inpatient setting for select individuals at high risk for hypoglycemia.<br />5. Patients already using personal CGM should continue using it in the inpatient setting, combined with periodic point-of-care blood glucose (POC-BG) testing.<br />6. Inpatient glycemic surveillance and management programs leveraging electronic health record (EHR) data are strongly recommended to identify and manage hypoglycemia risk.<br />7. Long-acting insulin analogs are suggested over human neutral protamine Hagedorn (NPH) insulin for those on basal insulin therapy at high risk of hypoglycemia.<br />8. Rapid-acting insulin analogs are recommended over short-acting human insulin for people on basal-bolus therapy at high risk of hypoglycemia.<br />9. A structured program of patient education regarding hypoglycemia management is recommended over unstructured advice for insulin-receiving patients.<br />10. Glucagon preparations that do not require reconstitution are preferred over those requiring reconstitution for managing severe outpatient hypoglycemia.<br /><br />The guideline emphasizes the importance of educating patients on using and interpreting CGM data, leveraging technology like EHR for proactive hypoglycemia management, and the potential cost-effectiveness of advanced treatments despite higher upfront costs. It also highlights that structured patient education plays a vital role in mitigating hypoglycemia.<br /><br />The guideline development involved a multidisciplinary team using GRADE methodology to assess evidence quality, considering various implementation factors, including patient preferences, feasibility, and potential resource requirements. The recommendations aim to inform clinical practice and healthcare system improvements, ultimately aiming to enhance care for individuals with diabetes who face significant risks of hypoglycemia.

Keywords

diabetes

hypoglycemia

continuous glucose monitoring

CGM

insulin

patient education

clinical guidelines

type 1 diabetes

type 2 diabetes

Endocrine Society


EndoCareers \| Contact Us \| Privacy Policy \| Terms of Use	CONNECT WITH US
© 2021 Copyright Endocrine Society. All rights reserved.	2055 L Street NW, Suite 600 \| Washington, DC 20036 202.971.3636 \| 888.363.6274