Hypoglycemia is a common concern for people with diabetes, especially those using insulin and sulfonylureas, as these medications increase the risk. It can lead to distress, medication nonadherence, disruption of daily life, and costly emergency care, along with higher morbidity and mortality. This review updates the diabetes-specific sections of the 2009 “Evaluation and Management of Adult Hypoglycemic Disorders” guidelines. It also addresses emerging issues related to hypoglycemia in both adults and children with diabetes, with the goal of reducing and preventing hypoglycemic events.

A multidisciplinary panel conducted systematic reviews and identified 10 key clinical questions on hypoglycemia risk and prevention, resulting in 10 recommendations. These include conditional recommendations for the use of real-time continuous glucose monitoring (CGM) and algorithm-driven insulin pumps for type 1 diabetes, CGM for patients with high-risk type 2 diabetes, and the use of long-acting insulin analogs. Strong recommendations were made for structured diabetes education programs, glucagon preparations that do not require reconstitution for severe hypoglycemia, and the use of CGM for select inpatient populations. The guidelines emphasize clinical outcomes, feasibility, and patient preferences, aiming to improve diabetes care and reduce hypoglycemia risks.

Reference: McCall AL, Lieb DC, Gianchandani R, et al. Management of Individuals With Diabetes at High Risk for Hypoglycemia: An Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. 2023;108(3):529-562. doi: 10.1210/clinem/dgac596. Erratum in: J Clin Endocrinol Metab. 2023;108(3):e44. doi: 10.1210/clinem/dgac737.