A Systematic Review Supporting the Endocrine Society Guidelines: Management of Diabetes and High Risk of Hypoglycemia
Authors' conclusion
This systematic review summarized the best available evidence about several interventions addressing hypoglycemia in people with diabetes. This evidence base will facilitate development of clinical practice guidelines by the Endocrine Society.
Study context
- Population
- People with diabetes at high risk for hypoglycemia
- Participants
- 43,344 people149 studies
- Comparison
- Interventions targeting hypoglycemia in people with diabetes
- Outcome
- Hypoglycemia outcomes by intervention
Methodological detailsGrading of Recommendations Assessment, Development and Evaluation (GRADE) certainty of evidence, meta-analysis when feasible, 10 guideline-panel questions
- GRADE certainty of evidence
- Meta-analysis when feasible
- 10 guideline-panel questions
Pooled result
As reported in the abstract
- Continuous glucose monitoring (CGM) reduced severe hypoglycemia episodes in T1D and the proportion with hypoglycemia (BG <54 mg/dL)
- No data on real-time CGM with algorithm-driven insulin pumps vs MDI with BG testing in T1D
- CGM in outpatients with T2D on insulin and/or SU reduced time with BG <70 mg/dL
- CGM initiated in hospitalized high-risk patients reduced hypoglycemia episodes with BG <54 mg/dL and time <54 mg/dL
- Proportion with hypoglycemia (BG <70 and <54 mg/dL) detected by CGM significantly higher than point-of-care BG testing
- No data on continuation of personal CGM in hospital
- Inpatient computerized glycemic management program using electronic health record data associated with fewer patients with and episodes of hypoglycemia (BG <70 mg/dL) and fewer patients with severe hypoglycemia vs standard care
- Long-acting basal insulin analogs associated with less hypoglycemia
- Rapid-acting insulin analogs associated with reduced severe hypoglycemia but more patients with mild to moderate hypoglycemia
- Structured diabetes education programs reduced severe hypoglycemia episodes and time <54 mg/dL in outpatients on insulin
- Glucagon formulations not requiring reconstitution associated with longer time to recovery; proportion fully recovered not different
Original publication
A Systematic Review Supporting the Endocrine Society Guidelines: Management of Diabetes and High Risk of Hypoglycemia. J Clin Endocrinol Metab. Published 7 December 2022. doi:10.
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