The mystery of hypoglycaemia

Hypoglycaemia poses a perennial problem for nurses managing diabetes. The BMJ discussed hypoglycaemia in type 1 diabetes (T1D) as long ago as 1923, but the causes of impaired awareness of hypoglycaemia (IAH) remain poorly understood. However, delegates at the recent Diabetes UK Professional Conference in London heard that research is beginning to transform nurses' understanding and management of hypoglycaemia.

A common problem

Several studies presented during the conference underscored that the prevalence of hypoglycaemia is often underestimated. For example, researchers from Leicester University performed a systematic review of 46 population-based studies of hypoglycaemia encompassing 532,542 patients with type 2 diabetes (T2D). On average, patients experienced 19 episodes of mild and moderate hypoglycaemia a year and 0.8 severe attacks. Hypoglycaemia was especially common among people taking insulin: 23 mild and moderate episodes and one severe attack a year. The annual incidences for regimens that included a sulphonylurea were two and 0.01 for mild/moderate and severe episodes respectively. The authors concluded that clinical trials probably underestimate hypoglycaemia risk. They add that the findings 'highlight the need for educational interventions and individualisation of therapies to reduce the risk of hypoglycaemia.'