An article published in Diabetologia this month challenges the accepted glucose cut-off values that define hypoglycemia because they have a major effect on reported frequencies of hypoglycemia.
Researchers set out to quantify the relationship between the frequency of hypoglycemia and various glucose cut-off points for the definition of hypoglycemia, within a range of A1c strata.
Data from two trials examining insulin glargine dose titration in 12,837 type 2 participants with diabetes starting insulin therapy were combined. Curves for hypoglycemia frequency plotted against endpoint A1c level were constructed, using a range of glucose cut-off points for hypoglycemia.
During the 12-week study period, 3,912 patients recorded 21,592 hypoglycemic episodes, which were classified as either “severe,” “symptomatic,” or “asymptomatic” events.
The researchers concluded that the glucose cut-off point defining hypoglycemia greatly affects the reported frequency of hypoglycemia. In order to have clinical relevance, and if hypoglycemia is to be defined by a predetermined glucose level, then the cut-off should be set at a lower level than the threshold of 3.9 mmol/l proposed by the American Diabetes Association.