University of Oklahoma Health Sciences Center

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Author/s:

Celeste C Thomas, Karishma Chopra, Andrew M Davis

Date Added:

March 26, 2024

Journal/Publication:

JAMA

Publisher:

American Medical Association

Publication Date:

March 14, 2024

URL:

Management of Outpatients With Diabetes at High Risk of Hypoglycemia

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.1001/jama.2024.1137

PMID (1):

38483370

Keywords

diabetes

Diabetes and Endocrinology

Endocrinology

insulin

MeSH

diabetes mellitus

diabetes mellitus, type 2

dipeptidyl-peptidase IV inhibitors

diabetes mellitus, type 1

blood glucose

Hypoglycemia

Insulins

RPR Commentary

Guidance for management of diabetes in patients at risk of hypoglycemia. James W. Mold, MD, MPH

Abstract

More than 30 million people in the US have diabetes, approximately 5% with type 1 and approximately 95% with type 2. About 5 million individuals in the US with type 2 diabetes use insulin and 7 million take sulfonylureas; both of these medications have a greater association with hypoglycemia than metformin, glucagon-like peptide 1 receptor agonists, dipeptidyl peptidase 4 inhibitors, or sodium-glucose cotransporter 2 inhibitors. Each month, 70% of people with type 1 diabetes experience some degree of hypoglycemia.1 Level 1 hypoglycemia is defined as blood glucose of 54 to 70 mg/dL; level 2 is less than 54 mg/dL; and severe hypoglycemia (level 3) occurs when low blood glucose levels cause neurologic or physical symptoms that require help from others. Furthermore, recurrent severe hypoglycemia increases risk of future dementia.2 Hypoglycemia occurs more often in people with lower education, lower income, and food insecurity.3 This synopsis focuses on outpatient management of diabetes with high risk of hypoglycemia; the guideline also addresses prevention of hypoglycemia in hospitalized patients.4

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