ADA 2017: Hypoglycemia and the Role of Glycemic Variability

Hypoglycemia Rates in Type 2 Diabetes Mellitus: Results of the Population-Based inHYPO-DM Study (Canada)

Incidence of hypoglycemia in patients with type 2 diabetes is particularly high when treated with insulin and sulfonylurea (SU) combination.

Conclusion:

Rates of reported hypoglycemia events in T2DM patients across a large Canadian population were high, particularly with insulin/sulfonylurea combination, followed by insulin alone relative to sulfonylurea alone. Severe episodes most common with combination.

Link to Abstract.

Higher Glycemic Variability is Associated with Increased Risk of Hypoglycemia in Well- or Poorly-controlled Type 1 or Type 2 Diabetes Patients

Continuous glucose monitoring was used to assess the relationship between blood glucose variability and hypoglycemia in well and poorly controlled type 1 and type 2 diabetes patients.

Conclusion:

With blood glucose variability strongly correlated to duration of hypoglycemia in diabetes patients with various degrees of metabolic control, strategies to reduce variability may be an effective way to reduce the risk of hypoglycemia.

Link to Abstract.

Going Beyond HbA1c in Predicting Hypoglycemia

The relation of glycemic variability to A1c in type 1 diabetes patients on basal-bolus insulin is examined to ascertain whether close monitoring of both measures can reduce episodes of hypoglycemia.

Hypoglycemia definition: interstitial glucose less than 3.0mmol/L for 20 minutes or more; frequency: number of events/duration of CGM; nocturnal hypoglycemia: occurring between 00:00 to 08:00h.

Little relationship found between A1c and hypoglycemia or glycemic variability, however, variability was correlated with frequency and duration of hypoglycemia.

Link to Abstract.

Conclusion:

Glucose variability in T1DM patients predicted hypoglycemia independent of A1c, by both continuous and self-monitoring. Measures of variability should be used to target those at risk of frequent hypoglycemia.