In This Issue of Diabetes Care

Hypoglycemia is related to increased risk for unfavorable outcomes in both adults and children. In 2012, the American Diabetes Association and The Endocrine Society convened a workgroup on hypoglycemia (p. 1384) to update guidelines and address several important issues related to hypoglycemia in diabetes. These included defi nitions and reporting, shortand long-term outcomes, treatment targets, prevention strategies, clinical recommendations, and existing knowledge gaps. The workgroup suggests that a glucose ≤70 mg/dL (≤3.9 mmol/L) should serve as an alert level for risk of hypoglycemia, and it defi nes several hypoglycemia subclassifi cations. These include severe hypoglycemia, documented symptomatic hypoglycemia, asymptomatic hypoglycemia, and probable symptomatic hypoglycemia. The new report discusses a number of hypoglycemia-related outcomes in detail including death, hypoglycemia-associated autonomic failure, central nervous system consequences (particularly in children and older adults), components of the geriatric syndrome (e.g., falls), inpatient outcomes, decreased quality of life, and limitations in activities of daily living. The report recommends that glycemic treatment targets should be individualized based on patient-specifi c characteristics such as age, life expectancy, comorbid conditions, patient preferences, and quality-of-life concerns. The workgroup endorses strategies for prevention and clinical care of hypoglycemia including patient education, monitoring and modifi cation of diet and exercise, medication adjustment, and tracking of both symptoms and glucose by patients and physicians. Finally, the report details existing knowledge gaps in the area of hypoglycemia. These gaps include lack of reliable and consistent hypoglycemia surveillance methods, defi nition of high-risk groups, development of new educational methods, advancing therapies to reduce glucose without hypoglycemia, creating patient-friendly technologies to monitor glycemia with greater accuracy, understanding the mechanisms of hypoglycemia and its outcomes, and better characterization of adverse outcomes. The new guidelines refl ect progress in the understanding of hypoglycemia and also detail the challenges that lie ahead. — Elsa S. Strotmeyer, PhD, MPH