HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Purchase Article View Shopping Cart Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Search for Related Content PubMed PubMed Citation Social Bookmarking                What's this?

Defining and Reporting Hypoglycemia in Diabetes

A report from the American Diabetes Association Workgroup on Hypoglycemia

Address correspondence and reprint requests to Philip E. Cryer, MD, Washington University School of Medicine, Department of Endocrinology/Metabolism, CB 8127 WashU, 660 S. Euclid Ave., Saint Louis, MO 63110. E-mail: pcryer@wustl.edu

Abbreviations: DCCT, Diabetes Control and Complications Trial

The first 300 words of the full text of this article appear below.

Iatrogenic hypoglycemia causes recurrent morbidity in most people with type 1 diabetes and in many with type 2 diabetes and is sometimes fatal. It also impairs defenses against subsequent hypoglycemia. Furthermore, the barrier of hypoglycemia precludes maintenance of euglycemia over a lifetime of diabetes; thus, full realization of the benefits of glycemic control is rarely achieved. Therefore, hypoglycemia is the critical limiting factor in the glycemic management of diabetes in both the short and long term (1).

Clinicians have recognized the problem of iatrogenic hypoglycemia since the first use of insulin in 1922 (2). The problem was underscored 70 years later by the finding that intensive glycemic therapy both decreased the frequency of long-term complications and increased the frequency of hypoglycemia in the Diabetes Control and Complications Trial (DCCT) (3,4). Despite steady improvements in the glycemic management of diabetes, and perhaps because of the impetus for glycemic control that resulted from the DCCT (3,4) and the U.K. Prospective Diabetes Study (5,6), recent population-based data indicate that hypoglycemia continues to be a major problem for people with both type 1 and type 2 diabetes (7–9).

The ultimate goal of the glycemic management of diabetes is a lifetime of euglycemia without hypoglycemia. That will undoubtedly require glucose-regulated insulin replacement or secretion (10). Pending that, the goal of new drugs, devices, or management strategies to be used for the glycemic management of diabetes is to both improve glycemic control and reduce the frequency and severity of hypoglycemia. How should new drugs, devices, or strategies be evaluated and reported from the perspective of hypoglycemia?

The American Diabetes Association assembled a Workgroup on Hypoglycemia in June of 2004 to discuss that issue and, . . . [Full Text of this Article]

HYPOGLYCEMIA IN DIABETES

QUESTIONS

A) How should hypoglycemia be defined?
1) Severe hypoglycemia.
2) Documented symptomatic hypoglycemia.
3) Asymptomatic hypoglycemia.
4) Probable symptomatic hypoglycemia.
5) Relative hypoglycemia.
B) How should hypoglycemia be reported?
C) What constitutes a meaningful reduction in hypoglycemia?
APPENDIX

Members of the ADA Workgroup on Hypoglycemia

CiteULike    Del.icio.us    Digg    Reddit    Technorati    What's this?

This article has been cited by other articles:

				N. R Pinelli, R. Cha, M. B Brown, and L. A Jaber Addition of Thiazolidinedione or Exenatide to Oral Agents in Type 2 Diabetes: A Meta-Analysis Ann. Pharmacother., November 1, 2008; 42(11): 1541 - 1551. [Abstract] [Full Text] [PDF]

				A. A. Ginde, D. J. Pallin, and C. A. Camargo Jr Hospitalization and Discharge Education of Emergency Department Patients With Hypoglycemia The Diabetes Educator, July 1, 2008; 34(4): 683 - 691. [Abstract] [Full Text] [PDF]

				J. L. Kitzmiller, J. M. Block, F. M. Brown, P. M. Catalano, D. L. Conway, D. R. Coustan, E. P. Gunderson, W. H. Herman, L. D. Hoffman, M. Inturrisi, et al. Managing Preexisting Diabetes for Pregnancy: Summary of evidence and consensus recommendations for care Diabetes Care, May 1, 2008; 31(5): 1060 - 1079. [Full Text] [PDF]

				P. Rossetti, F. Porcellati, G. B. Bolli, and C. G. Fanelli Prevention of Hypoglycemia While Achieving Good Glycemic Control in Type 1 Diabetes: The role of insulin analogs Diabetes Care, February 1, 2008; 31(Supplement_2): S113 - S120. [Full Text] [PDF]

				J. C. Pickup and E. Renard Long-Acting Insulin Analogs Versus Insulin Pump Therapy for the Treatment of Type 1 and Type 2 Diabetes Diabetes Care, February 1, 2008; 31(Supplement_2): S140 - S145. [Abstract] [Full Text] [PDF]

				L. R. Nielsen, U. Pedersen-Bjergaard, B. Thorsteinsson, M. Johansen, P. Damm, and E. R. Mathiesen Hypoglycemia in Pregnant Women With Type 1 Diabetes: Predictors and role of metabolic control Diabetes Care, January 1, 2008; 31(1): 9 - 14. [Abstract] [Full Text] [PDF]

				B. Keymeulen, P. Gillard, C. Mathieu, B. Movahedi, G. Maleux, G. Delvaux, D. Ysebaert, B. Roep, E. Vandemeulebroucke, M. Marichal, et al. Correlation between beta cell mass and glycemic control in type 1 diabetic recipients of islet cell graft PNAS, November 14, 2006; 103(46): 17444 - 17449. [Abstract] [Full Text] [PDF]

				S. Donaldson, G. Villanuueva, L. Rondinelli, and D. Baldwin Rush University Guidelines and Protocols for the Management of Hyperglycemia in Hospitalized Patients: Elimination of the Sliding Scale and Improvement of Glycemic Control Throughout the Hospital The Diabetes Educator, November 1, 2006; 32(6): 954 - 962. [Abstract] [Full Text] [PDF]

				B. P. Kovatchev, E. Otto, D. Cox, L. Gonder-Frederick, and W. Clarke Evaluation of a new measure of blood glucose variability in diabetes. Diabetes Care, November 1, 2006; 29(11): 2433 - 2438. [Abstract] [Full Text] [PDF]

				G. B. Bolli Glucose Variability and Complications Diabetes Care, July 1, 2006; 29(7): 1707 - 1709. [Full Text] [PDF]

				B. Raju, A. M. Arbelaez, S. M. Breckenridge, and P. E. Cryer Nocturnal Hypoglycemia in Type 1 Diabetes: An Assessment of Preventive Bedtime Treatments J. Clin. Endocrinol. Metab., June 1, 2006; 91(6): 2087 - 2092. [Abstract] [Full Text] [PDF]

				The Diabetes Research in Children Network (DirecNe The Effects of Aerobic Exercise on Glucose and Counterregulatory Hormone Concentrations in Children With Type 1 Diabetes Diabetes Care, January 1, 2006; 29(1): 20 - 25. [Abstract] [Full Text] [PDF]

				I. M. Wentholt, M. A. Vollebregt, A. A. Hart, J. B. Hoekstra, and J. H. DeVries Comparison of a Needle-Type and a Microdialysis Continuous Glucose Monitor in Type 1 Diabetic Patients Diabetes Care, December 1, 2005; 28(12): 2871 - 2876. [Abstract] [Full Text] [PDF]