Hypoglycemia and Diabetes: A Report of a Workgroup of the American Diabetes Association and The Endocrine Society

  1. Robert Vigersky, MD10
  1. From the 1Department of Medicine, University of Minnesota, Minneapolis, Minnesota;
  2. 2The Frist Clinic, Nashville, Tennessee;
  3. 3Mid-America Diabetes Associates, Wichita, Kansas; the
  4. 4Division of Endocrinology, Diabetes and Metabolism, Washington University School of Medicine, Saint Louis, Missouri; the
  5. 5Division of Endocrinology, Diabetes and Metabolism, University of Tennessee Health Science Center, Memphis, Tennessee,
  6. 6Diabetes, Metabolism and Endocrinology/Internal Medicine, Park Nicollet Clinic, Saint Louis Park, Minnesota; the
  7. 7Academic Unit of Diabetes, Endocrinology and Metabolism, School of Medicine and Biomedical Sciences, University of Sheffield, Sheffield, U.K.; the
  8. 8Diabetes Center, University of South Florida College of Medicine, Tampa, Florida;
  9. 9Diabetes Services, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts; and the
  10. 10Diabetes Institute, Walter Reed National Military Medical Center, Bethesda, Maryland.
  1. Corresponding author: Elizabeth R. Seaquist, seaqu001{at}


OBJECTIVE To review the evidence about the impact of hypoglycemia on patients with diabetes that has become available since the past reviews of this subject by the American Diabetes Association and The Endocrine Society and to provide guidance about how this new information should be incorporated into clinical practice.

PARTICIPANTS Five members of the American Diabetes Association and five members of The Endocrine Society with expertise in different aspects of hypoglycemia were invited by the Chair, who is a member of both, to participate in a planning conference call and a 2-day meeting that was also attended by staff from both organizations. Subsequent communications took place via e-mail and phone calls. The writing group consisted of those invitees who participated in the writing of the manuscript. The workgroup meeting was supported by educational grants to the American Diabetes Association from Lilly USA, LLC and Novo Nordisk and sponsorship to the American Diabetes Association from Sanofi. The sponsors had no input into the development of or content of the report.

EVIDENCE The writing group considered data from recent clinical trials and other studies to update the prior workgroup report. Unpublished data were not used. Expert opinion was used to develop some conclusions.

CONSENSUS PROCESS Consensus was achieved by group discussion during conference calls and face-to-face meetings, as well as by iterative revisions of the written document. The document was reviewed and approved by the American Diabetes Association’s Professional Practice Committee in October 2012 and approved by the Executive Committee of the Board of Directors in November 2012 and was reviewed and approved by The Endocrine Society’s Clinical Affairs Core Committee in October 2012 and by Council in November 2012.

CONCLUSIONS The workgroup reconfirmed the previous definitions of hypoglycemia in diabetes, reviewed the implications of hypoglycemia on both short- and long-term outcomes, considered the implications of hypoglycemia on treatment outcomes, presented strategies to prevent hypoglycemia, and identified knowledge gaps that should be addressed by future research. In addition, tools for patients to report hypoglycemia at each visit and for clinicians to document counseling are provided.

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