Abstract
Keywords
Severe Hypoglycemia | Documented Symptomatic Hypoglycemia | Asymptomatic (Documented) Hypoglycemia | Probable Symptomatic Hypoglycemia | Pseudo-hypoglycemia |
---|---|---|---|---|
Requires assistance of a third party and is ameliorated by normalization of plasma glucose | Typical symptoms accompanied by measured plasma glucose ≤70 mg/dL | Measured plasma glucose ≤70 mg/dL but without typical symptoms | Typical symptoms responding to self-treatment but not confirmed by biochemical documentation but presumably caused by plasma glucose ≤70 mg/dL | Typical symptoms but with a measured plasma glucose greater than but approaching 70 mg/dL |
Frequency of Hypoglycemia
Risk Factors/Behaviors Predisposing to Hypoglycemia
No. of Trials | Risk of Overall Hypoglycemia | ||||
---|---|---|---|---|---|
Traditional Meta-analysis | Mixed-Treatment Meta-analysis | ||||
Relative Risk | 95% CI | Relative Risk | 95% Credible Interval | ||
Sulfonylureas | 3 | 2.63 | 0.76-9.13 | 4.57 | 2.11-11.45 |
Glinides | 2 | 7.92 | 1.45-43.21 | 7.50 | 2.12-41.52 |
Thiazolidinediones | 2 | 2.04 | 0.50-8.23 | 0.56 | 0.19-1.69 |
AGIs | 2 | 0.60 | 0.08-4.55 | 0.42 | 0.01-9.00 |
DPP4-inhibitors | 8 | 0.67 | 0.30-1.50 | 0.63 | 0.26-1.71 |
GLP-1 analogs | 2 | 0.94 | 0.42-2.12 | 0.89 | 0.22-3.96 |
Subgroups at Risk
Patients with Renal Insufficiency
Elderly Patients
- Inzucchi S.E.
- Bergenstal R.M.
- Buse J.B.
- et al.
People with Hypoglycemia Unawareness and Hypoglycemia-Associated Autonomic Failure
Consequences of Hypoglycemia
Clinical Consequences
Economic Consequences
Psychosocial/Quality of Life Consequences
- Alvarez-Guisasola F.
- Tofe P.S.
- Krishnarajah G.
- et al.
Health Care Reform Issues
Centers for Medicare and Medicaid Services. Last updated 2013. Physician Quality Reporting System. Available at: http://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/PQRS/index.html?redirect=/pqrs. Accessed December 2013.
National Committee for Quality Assurance. Last updated 2013. HEDIS & Performance Measurement. Available at: http://www.ncqa.org/HEDISQualityMeasurement.aspx. Accessed December 2013.
Centers for Medicare and Medicaid Services. Last updated 2012. CMS Proposals for the Physician Value-Based Payment Modifier under the Medicare Physician Fee Schedule. Available at: http://www.cms.gov/Outreach-and-Education/Outreach/NPC/Downloads/8-1-12-VBPM-NPC-Presentation.pdf. Accessed December 2013.
Patient Management Issues
Improving Self-Treatment
Avoiding Hypoglycemia-Associated Autonomic Failure and Impaired Hypoglycemia Awareness
Selecting and Modifying Therapy to Reduce Risk
- Inzucchi S.E.
- Bergenstal R.M.
- Buse J.B.
- et al.
Conclusions
Acknowledgments
References
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Article Info
Footnotes
Funding: The publication of this manuscript was funded by Novo Nordisk Inc.
Conflict of Interest: JM has served on advisory boards for Novo Nordisk and Boehringer Ingelheim, and is on the speakers bureau for Novo Nordisk, Boehringer Ingelheim, Ortho Biotec, and Warner Chilcott. DS has served on advisory boards for Novo Nordisk, Janssen, and Lilly.
Authorship: The authors take full responsibility for the content of this manuscript. Writing support was provided by Watermeadow Medical.