Reduction of Recurrent Severe Hypoglycemia and Hypoglycemia Unawareness in Type 2 Diabetes by Treatment Modification and Diabetes Education

Introduction: Intensification of diabetes treatment can induce hypoglycemia, representing a barrier to achieve glycemic control increasing the risks of adverse events. Objectives: To describe changes in the frequency and severity of hypoglycemia following treatment modification in high-complexity type 2 diabetics (T2DM).Material and Methods: T2DM patients with chronic diabetes complications presenting severe, recurrent and reduced awareness of hypoglycemia (RAH) were analyzed before and three months after treatment modification and diabetes education.Results: Twelve males aged 68.5 ± 12.6 years-old, BMI: 28.9 ± 4.3 kg/m 2 ; glycosylated hemoglobin A1c (HbA1c) 8.0 ± 0.8% and ten females aged: 67.6 ± 8.4 years-old, BMI 31.7 ± 6.2.0 kg/m 2 , HbA1c 8.4 ± 2.0%, with multiple cardiovascular risk factors, previous cardiovascular disease or renal impairment, requiring insulin treatment alone or with oral agents, were evaluated.All had severe and recurrent hypoglycemia events.Nutritional counselling and diabetes education were provided to all the patients; the pharmacologic treatment was switched from human insulin to insulin analogues and to newer class of oral agents or to GLP-1 receptor agonists.With treatment modification and diabetes education, the frequency and severity of hypoglycemia events diminished.Further, mean insulin doses were reduced from 0.70 ± 0.24 to 0.44 ± 0.9 U/Kg (p=0.01) and from 0.87 ± 0.41 to 0.47 ± 0.21 U/ Kg in males and females, respectively (p=0.0001).Concomitantly, HbA1c diminished in females (p=0.02) and for both males and females, the coefficient of variation of fasting glucose declined (p=0.03). Conclusion:Recurrent severe hypoglycemia and RAH constitute a serious complication which hampers metabolic control and place patients at risk for cognitive dysfunction and cardiovascular complications.Reduction in the frequency, severity of hypoglycemia in high-complexity T2DM was observed after diabetes treatment modification.