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How Low Should Diabetes Patients Go in Lowering Blood Sugar

LEICESTER, ENGLAND – The sometimes singular focus on lowering blood sugar in type 2 diabetes patients might be too much of a good thing and lead to significant health risks.

That’s according to a new British study, published recently in the journal PLOS ONE, which finds that hypoglycemia is especially prevalent among patients using insulin but also occurs surprisingly often in those using other treatment regimens.

Researchers from the University of Leicester and Leicester's Hospitals in England looked at both mild cases, which are resolved without outside help, or severe cases, where either emergency medical care or assistance are required.

The review included 532,542 participants – nearly half of whom had experienced mild hypoglycemia and 6% who had experienced severe hypoglycemia. On average, the study subjects had 19 mild episodes per year and just less than one severe episode per year.

Hypoglycemia was found to be especially common among insulin users with prevalence of mild/moderate episodes at 50%, averaging 23 events per person-year, and prevalence of severe episodes of 21%, with an average of one a year.

For treatment regimens including a sulphonylurea, mild/moderate prevalence was 30% and incidence of two events per person-year, and severe event prevalence was 5% and an incidence of 0.01 events per person-year. A similar prevalence of 5% of severe events was found for treatment regimens that did not include sulphonylureas.

"Our results highlight an urgent need for raising awareness amongst patients and healthcare professionals about hypoglycemia,” said lead author Chloe Louise Eldridge, a postgraduate researcher. “This study particularly highlights the need for patient education to raise awareness of hypoglycemia and the consideration of a patient's hypoglycemia risk by healthcare professionals when prescribing diabetes treatments.”

Study authors point out that hypoglycemia significantly affects patient quality of life, employment, social interactions, and driving.

“In addition to the direct effects of hypoglycemia, there may be a substantial indirect impact on serious long-term health consequences from medication non-adherence and purposeful hyperglycemia, due to fear and avoidance of hypoglycemia,” they add.

The authors note that previous reviews often have focused on clinical trial data, not real- world settings: