Endocrine Abstracts

Hypoglycaemia is associated with considerable morbidity and even mortality in type 1, and less likely in type 2 diabetes. Generally, hypoglycaemia is accepted as a surrogate marker of poor health as it is likely to be more prevalent in renal and liver failures, which independently increase cardiovascular diasease (CVD) and neurocognitive risks. Hypoglycaemia, have been implicated with a fortunately rare but tragic event, ‘dead-in-bed’ syndrome. It has been hypothesised that nocturnal hypoglycaemia can lead to the dead-in-bed syndrome via its pro-arrhythmogenic effects. Hypopglycaemia, due to its effects on inflammation and thrombosis can increase CV risk in both types of diabetes. In addition to adverse biological effects, repeated hypoglycaemias has been shown to significantly impair quality of life, and leading to depression in older people with diabetes. Negative psychological effects of hypoglycaemia are particularly deleterious as they can establish a cognitive barrier preventing treatment of future episodes and thus interfering the treatment of hypoglycemia-associated autonomic failure (HAAF). Hypoglycaemia has a significant impact on the risk of fall and related injuries, and dementia or cognitive impairment by various mechanisms. Hypoglycaemia is a major limiting factor for optimising glycaemic control, especially in patients with long-duration type 1, as well as in older patients with type 2 diabetes. Impaired renal and hepatic metabolism with slower counterregulatory mechanisms, polypharmacy or non-adherence to medications, as well as erratic or poor food intake are the key components of hypoglycaemia in older individuals. Simply relaxing HbA1c goals may reduce the risk but it is not sufficient to protect frail older people against hypoglycaemia. These people may benefit from a switch to regimens including anti-hyperglycaemic drugs that do not induce hypoglycaemia. In conclusion, hypoglycaemia remains a real and continuing problem for people with diabetes. Developing strategies, technologies, and/or therapies designed to prevent and/or minimize the risk of hypoglycaemia is utmost important.