Clinical Research and Evidence Based Medicine Unit, Second Medical Department, Aristotle University Thessaloniki, Thessaloniki, Greece.
Diabetes Center, Second Medical Department, Aristotle University Thessaloniki, Thessaloniki, Greece.
Curr Diabetes Rev. 2024;20(6):e201023222415. doi: 10.2174/0115733998271244231010100747.
Hypoglycemia is a limiting adverse effect of glucose-lowering medications and particularly insulin replacement therapy. This review provides insights into the burden of hypoglycemia in the management of diabetes and outlines strategies available to reduce the risk of hypoglycemia and improve patients' well-being. People with type 1 diabetes are primarily affected by hypoglycemic episodes which are associated with direct physical harms like injuries and cardiac events as well as indirect psychosocial consequences including constant anxiety, absenteeism, increased healthcare costs and overall poorer quality of life. These complications are more prominent amongst individuals with hypoglycemia unawareness or overnight hypoglycemia and could even extend to caregivers such as parents of children with diabetes. Patients experiencing frequent or severe hypoglycemic events might also develop a pathological fear of hypoglycemia and adopt aberrant behaviors intending to maintain higher blood glucose levels. Modern pharmaceutical options with a safer profile in terms of hypoglycemia are available including novel basal insulins with lower rates of nocturnal hypoglycemia along with ultra-rapid-acting insulin analogs with a shorter duration of action that might avert late post-meal hypoglycemia. Continuous glucose monitoring and sensor-augmented insulin pump therapy with low glucose suspend technology can also prevent hypoglycemia, although concerns about cost and patient satisfaction remain. Advancements in insulin therapy and technological modalities should be coupled with ongoing education and support for patients to become co-managers of their disease and reduce the risk of hypoglycemia.
低血糖是降糖药物，尤其是胰岛素替代治疗的一种限制不良作用。本综述提供了有关糖尿病管理中低血糖负担的见解，并概述了降低低血糖风险和改善患者生活质量的可用策略。1 型糖尿病患者主要受到低血糖发作的影响，这些发作与直接的身体伤害（如受伤和心脏事件）以及间接的心理社会后果（包括持续焦虑、缺勤、增加医疗保健费用和整体较差的生活质量）有关。这些并发症在低血糖意识障碍或夜间低血糖患者中更为突出，甚至可能延伸至照顾者，如糖尿病儿童的父母。经常或严重发生低血糖事件的患者也可能会对低血糖产生病理性恐惧，并采取异常行为来维持更高的血糖水平。在低血糖方面具有更安全特性的现代药物选择包括低血糖发生率较低的新型基础胰岛素以及作用持续时间较短的超快速作用胰岛素类似物，它们可能避免餐后晚期低血糖。连续血糖监测和带有低血糖暂停功能的传感器增强型胰岛素泵治疗也可以预防低血糖，尽管对成本和患者满意度的担忧仍然存在。胰岛素治疗和技术模式的进步应与对患者的持续教育和支持相结合，使他们成为疾病的共同管理者，并降低低血糖风险。
