Nocturnal hypoglycemia in type 1 and type 2 diabetes: an update on prevalence, prevention, pathophysiology and patient awareness

ABSTRACT

Introduction

Despite considerable progress in diabetes treatment, prevalence of nocturnal hypoglycemia in type 1 diabetes mellitus (T1DM) and advanced insulin treated type 2 diabetes mellitus (T2DM) remains high.

Areas covered

The present manuscript describes the prevalence of night-time hypoglycemia as reported in observational and randomized controlled trials. Factors that affect the risk of hypoglycemia are highlighted. The authors also describe impaired awareness of hypoglycemia and available preventive methods.

Expert opinion

Prevention of nocturnal hypoglycemia includes behavioral, dietary and pharmacologic interventions. The most recent development with the lowest rate of hypoglycemia is sensor-augmented pumps with predictive low glucose suspend technology. These pumps combine continuous subcutaneous insulin infusion with continuous glucose monitoring and use various algorithms to predict and stop hypoglycemia before it develops.

KEYWORDS:

• Diabetes
• glucose
• prevention of hypoglycemia
• nocturnal hypoglycemia
• prevalence of hypoglycemia

Article highlights

• Global prevalence of nocturnal hypoglycemia is up to 73% as reported in observational studies.

• Some of the factors that increase the risk of nocturnal hypoglycemia include older age, female gender, longer duration of diabetes and comorbidities.

• Terbutaline – a beta 2 adrenergic agonist – is an adjunctive agent that has been shown to prevent nocturnal hypoglycemia but also cause rebound hyperglycemia.

• Combination of continuous subcutaneous insulin infusion with continuous glucose monitoring in a pump that uses various algorithms and predicts falling blood glucose is the best option currently available for the prevention of nocturnal hypoglycemia.

• Combination of patient education, pharmaceuticals and technology has been shown to considerably improve hypoglycemic awareness.

Declaration of interest

The author(s) have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers of this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper received no funding.