Spotlight on hypoglycemia

Three studies published in December looked at hypoglycemia, focusing on rates of severe hypoglycemia in the U.S., patients at high risk for hypoglycemia, and potential use of intranasal glucagon to treat the condition.

Hypoglycemia was the focus of 3 recent studies, all published online by Diabetes Care on Dec. 17, 2015.

The first study looked at severe hypoglycemia among almost a million U.S. adults with diabetes. Between 2005 and 2011, rates of hypoglycemia requiring medical intervention were between 1.4 and 1.6 events per 100 person-years, the authors found. Older age; depression; higher HbA1c; and use of insulin, insulin secretagogues, and beta-blockers were all associated with hypoglycemia. Chronic kidney disease, congestive heart failure, and cardiovascular disease were also associated with increased risk, but rates of hypoglycemia dropped significantly among these patients over the course of the study, possibly due to increased monitoring or new treatments, the authors speculated. The observed rate of severe hypoglycemia in this observational study was higher than that in randomized trials, the authors noted. They called for the data to be used to develop strategies to reduce severe hypoglycemia.

The second study looked specifically at a group at high risk for hypoglycemia, older adults with type 1 diabetes. The case-control study included 101 patients age 60 years or older who had had at least 1 severe hypoglycemic event in the past year and 100 similar controls who hadn't had severe hypoglycemia in 3 years. Both groups had similar HbA1cs and mean glucose levels, according to a continuous glucose monitor. They differed in hypoglycemia unawareness: Only 11% of the case-patients reported always having symptoms, compared to 43% of controls. Case-patients also had greater glycemic variability than controls. Patients who had hypoglycemia were also more likely to be taking beta-blockers. The results show that the patients' hypoglycemia was not the result of tighter glycemic control, and thus raising HbA1c goals is unlikely to resolve the problem of severe hypoglycemia, the study authors said. They recommended frequent home glucose measurement and consideration of minimizing beta-blocker use in patients at risk of hypoglycemia.

The third study assessed intranasal glucagon, which is not yet commercially available, as a potential treatment for hypoglycemia. The randomized crossover noninferiority trial induced hypoglycemia, using insulin, in 75 adults with type 1 diabetes. Glucagon was administered either intranasally or intramuscularly.

In only 1 instance did intranasal glucagon fail to successfully increase blood glucose levels to 70 mg/dL (3.89 mmol/L) within 30 minutes. The mean time to this success criterion was 16 minutes for intranasal and 13 minutes for intramuscular. Intranasal use was associated with more head and facial discomfort (25% of patients). Although intranasal glucagon took longer to work in the study, it would likely be faster for untrained people to administer than the intramuscular version, the study authors said. They concluded that the new formulation can be expected to benefit patients once it's commercially available.