Emergency treatment of hypoglycaemia: a guideline and evidence review

Aim To examine the current treatment guidelines for the emergency management of hypoglycaemia and the evidence underpinning recommendations. Methods International diabetes agencies were searched for hypoglycaemia treatment guidelines. Guidelines were assessed using the Appraisal of Guidelines Research and Evaluation II (AGREE II) instrument. An electronic database search was conducted for evidence regarding emergency treatment of hypoglycaemia in adults, and relevant articles were critically appraised. Results Of the international diabetes agencies, six sets of guidelines were deemed relevant and of sufficient detail for appraisal by AGREE II. The evidence search returned 2649 articles, of which 17 pertaining to the emergency management of hypoglycaemia were included. High‐quality evidence for the management of hypoglycaemia was lacking, limiting treatment recommendations. In general, guidelines and studies were somewhat concordant and recommended 15–20 g of oral glucose or sucrose, repeated after 10–15 min for treatment of the responsive adult, and 10% intravenous dextrose or 1 mg intramuscular glucagon for treatment of the unresponsive adult. No evidence was found for other treatment approaches. Conclusion Evidence for the emergency treatment of hypoglycaemia in adults is limited, is often low grade and mostly pre‐dates contemporary management of diabetes. Guideline recommendations are limited by the lack of randomized trials. Further high‐quality studies are required to inform the optimum management of this frequently occurring emergency condition. What's new? Despite the frequency and risks of hypoglycaemia, high‐grade evidence for its treatment is lacking, leading to guidelines based on low‐grade evidence or expert opinion. Treatment of ‘hypoglycaemia responding to commands’ with oral glucose and treatment of ‘hypoglycaemia not responding to commands’ with intravenous dextrose or glucagon is generally supported by the available evidence; however, very limited low‐quality evidence regarding optimum dosage and repeat treatment times was found. High‐quality trials to inform treatment guidelines are required for patients, their families and the emergency healthcare professionals managing hypoglycaemia.