Impact

Clip art hand with index finger pushing red bullseye

An episode of severe hypoglycaemia can lead to confusion, loss of consciousness and seizures,1 with a concomitant increase in the risk of falls, injuries, and hospitalisation. Nocturnal hypoglycemia may impair sleep quality and quantity, thus reducing well-being on the following day.2 Fear of hypoglycaemia, in turn, can compromise adherence to medical treatment.3

Recurrent hypoglycaemia has been shown to lower the glucose level that triggers the counterregulatory physiological response, leading to a significantly greater risk of subsequent severe hypoglycaemia.1
[See section on Impaired Awareness of Hypoglycaemia.]

Long-term clinical impact

  • Type 1 diabetes: Data from the DCCT (adult) cohort did not find a link between past episodes of severe hypoglycaemia and decreased cognitive function,1 but children may be at greater risk of hypoglycaemia-related cognitive deficits.4
  • Type 2 diabetes: The ACCORD, ADVANCE and VADT trials found an association between severe hypoglycaemia and subsequent mortality.1 Symptomatic hypoglycaemia (whether mild or severe) has also been linked to an increased risk of cardiovascular events.5

References

  1. Edelman SV, Blose JS. the impact of nocturnal hypoglycemia on clinical and cost-related issues in patients with type 1 and type 2 diabetes. Diabetes Educ 2014;40:269.
  2. Schneider G. Exorcising the specter of night-time hypoglycemia. Diabetes self-management. http://www.diabetesselfmanagement.com/managing-diabetes/blood-glucose-management/exorcising-the-specter-of-nighttime-hypoglycemia/
  3. King P et al. Well-being, cerebral function, and physical fatigue after nocturnal hypoglycemia in IDDM. Diabetes Care 1998;21:341.
  4. Walz L et al. Impact of symptomatic hypoglycemia on medication adherence, patient satisfaction with treatment, and glycemic control in patients with type 2 diabetes. Pat Pref Adher 2014;8:593.
  5. Hannonen R et al. Neurocognitive functioning in children with type-1 diabetes with and without episodes of severe hypoglycaemia. Dev Med Child Neurol 2003;45:262.