Minimizing the risk of hypoglycemia in patients with type 2 diabetes mellitus

Abstract

Hypoglycemia is a major barrier to achieving glycemic goals in patients with diabetes. Both acute and chronically recurrent hypoglycemic events appear to have long-term consequences for patients with type 2 diabetes mellitus (T2DM). Chronically recurrent hypoglycemia may lead to an impairment of the counterregulatory system, with the potential for the development of hypoglycemia unawareness syndrome, increased severe hypoglycemia-associated hospitalization, and increased mortality. Hypoglycemic events may also have negative implications in cardiovascular disease and/or dementia. Avoidance of hypoglycemia by treating with appropriate, individualized regimens for patients with T2DM should be a primary focus of physicians. Utilizing traditional agents (eg, metformin and thiazolidinediones) that do not promote hypoglycemia, in combination with newer agents such as dipeptidyl peptidase-4 inhibitors and incretin mimetics, could offer a therapeutic advantage when trying to help patients reach their hemoglobin A_1c goal without the added risk of hypoglycemia.

Keywords:

• hypoglycemia
• type 2 diabetes mellitus
• incretin
• dipeptidyl peptidase-4 inhibitors
• diabetes management

Acknowledgement

The author is solely responsible for the content of this review. Funding for this review was provided by Bristol-Myers Squibb and AstraZeneca. Medical writing and editorial assistance for this manuscript was provided by Trina Ricci, PhD, of Quintiles.

Disclosures

Dr Kushner has served on advisory boards for AstraZeneca, Bristol-Myers Squibb, and Eli Lilly and Company. She has served as a consultant for Eli Lilly and Company, and has been an investigator for Bristol-Myers Squibb and AstraZeneca.