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Cedars-Sinai Diabetes Leader Aids Development of New Hypoglycemia Guidelines

Clinical guidelines for the management of adult diabetes patients at high risk for hypoglycemia were recently updated by the Endocrine Society. Roma Gianchandani, MD, medical director of Diabetes Quality and vice chair of Quality and Innovation at Cedars-Sinai, is a co-author of the guidelines.

“There has been an explosion of diabetes drugs and technology over the last decade. The updated Endocrine Society Guidelines is an evidence-based resource for clinicians to identify subsets of diabetes patients who have a significant risk of hypoglycemia and to prioritize use of technology and therapies to help them mitigate that risk,” said Gianchandani, an endocrinologist. 

“In glucose management, we have always walked a tightrope between achieving good glucose control and hypoglycemia. Our expanded toolbox will greatly improve the ability of clinicians and patients to overcome the hypoglycemia barrier,” said Gianchandani.

The hormone insulin plays a critical role in stabilizing blood glucose levels for patients with type 1 or type 2 diabetes. Taking more insulin or oral medications than you need can cause blood sugar levels to drop too low. A severe and prolonged episode of hypoglycemia can result in loss of consciousness, seizures or even coma.

Two major developments in diabetes care can reduce hypoglycemia: therapeutics and reliable glucose-sensing technology. 

Continuous glucose monitoring (CGM) devices are sensors worn just under the skin that provide real-time blood sugar information and can also warn patients about impending hypoglycemia. New oral and injectable diabetes medications with rapid-acting to long-acting formulations of insulin and glucagon preparations can further prevent hypoglycemia.

“The people we care for should be aware of these new advances, which can help them minimize their risk for hypoglycemia and achieve a fine blood sugar balance,” said Gianchandani.

The updated guidelines apply to hospitalized patients as well as outpatients. Gianchandani says that reducing episodes of hypoglycemia for hospitalized patients at Cedars-Sinai is a priority for staff. Increasing access to CGM devices and high-quality diabetes education is key for high-risk patients.

“For people living with diabetes, glucose levels need to be managed with every meal or activity. Appropriate therapies described in these guidelines can help improve quality of life and productivity while reducing the fear of developing hypoglycemia,” said Gianchandani.