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 Resear...
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| Veröffentlicht in: | Diabetic medicine 2017-09, Vol.34 (9), p.1205-1211 |
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| creator | Villani, M. Courten, B. Zoungas, S. |
| description | 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. |
| doi_str_mv | 10.1111/dme.13379 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_1896037335</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>1896037335</sourcerecordid><originalsourceid>FETCH-LOGICAL-c3539-f9ae7bd3931fddaa32c541decdf2b20f1d3462af6c248030f442245df25158cf3</originalsourceid><addsrcrecordid>eNp1kMlOwzAQhi0EoqVw4AVQJC5wSOsti7mhEhapiAucLdcel1RZipNQ5e1xSeGAxFxmLH_6Z_QhdE7wlPiamRKmhLFEHKAx4TEPIy7IIRrjhNOQ4YSM0EnTrDEmVDBxjEY05UnCCRujLCvBraDSfdA6UG0JVRvUNnjvN_Wq6LWCMlc3gQpWXW6gyCsIVGUC-PSvSkPg_ATbU3RkVdHA2b5P0Nt99jp_DBcvD0_z20WoWcREaIWCZGmYYMQaoxSjOuLEgDaWLim2xDAeU2VjTXmKGbacU8oj_xuRKNWWTdDVkLtx9UcHTSvLvNFQFKqCumskSUWMWcL8tgm6_IOu685V_jpJxE4DpgJ76nqgtKubxoGVG5eXyvWSYLlzK71b-e3Wsxf7xG5Zgvklf2R6YDYA27yA_v8kefecDZFffEiCCQ</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1929390290</pqid></control><display><type>article</type><title>Emergency treatment of hypoglycaemia: a guideline and evidence review</title><source>MEDLINE</source><source>Access via Wiley Online Library</source><creator>Villani, M. ; Courten, B. ; Zoungas, S.</creator><creatorcontrib>Villani, M. ; Courten, B. ; Zoungas, S.</creatorcontrib><description>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.</description><identifier>ISSN: 0742-3071</identifier><identifier>EISSN: 1464-5491</identifier><identifier>DOI: 10.1111/dme.13379</identifier><identifier>PMID: 28477413</identifier><language>eng</language><publisher>England: Wiley Subscription Services, Inc</publisher><subject>Adult ; Adults ; Clinical trials ; Dextrose ; Diabetes ; Diabetes mellitus ; Diabetes Mellitus - blood ; Diabetes Mellitus - drug therapy ; Emergency Treatment - methods ; Emergency Treatment - standards ; Evidence-Based Practice ; Glucagon ; Humans ; Hypoglycemia ; Hypoglycemia - therapy ; Hypoglycemic Agents - administration & dosage ; Hypoglycemic Agents - adverse effects ; Intravenous administration ; Practice Guidelines as Topic - standards ; Risk factors ; Sucrose</subject><ispartof>Diabetic medicine, 2017-09, Vol.34 (9), p.1205-1211</ispartof><rights>2017 Diabetes UK</rights><rights>2017 Diabetes UK.</rights><rights>Diabetic Medicine © 2017 Diabetes UK</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3539-f9ae7bd3931fddaa32c541decdf2b20f1d3462af6c248030f442245df25158cf3</citedby><cites>FETCH-LOGICAL-c3539-f9ae7bd3931fddaa32c541decdf2b20f1d3462af6c248030f442245df25158cf3</cites><orcidid>0000-0002-5388-5709</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1111%2Fdme.13379$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1111%2Fdme.13379$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>315,782,786,1419,27931,27932,45581,45582</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/28477413$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Villani, M.</creatorcontrib><creatorcontrib>Courten, B.</creatorcontrib><creatorcontrib>Zoungas, S.</creatorcontrib><title>Emergency treatment of hypoglycaemia: a guideline and evidence review</title><title>Diabetic medicine</title><addtitle>Diabet Med</addtitle><description>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.</description><subject>Adult</subject><subject>Adults</subject><subject>Clinical trials</subject><subject>Dextrose</subject><subject>Diabetes</subject><subject>Diabetes mellitus</subject><subject>Diabetes Mellitus - blood</subject><subject>Diabetes Mellitus - drug therapy</subject><subject>Emergency Treatment - methods</subject><subject>Emergency Treatment - standards</subject><subject>Evidence-Based Practice</subject><subject>Glucagon</subject><subject>Humans</subject><subject>Hypoglycemia</subject><subject>Hypoglycemia - therapy</subject><subject>Hypoglycemic Agents - administration & dosage</subject><subject>Hypoglycemic Agents - adverse effects</subject><subject>Intravenous administration</subject><subject>Practice Guidelines as Topic - standards</subject><subject>Risk factors</subject><subject>Sucrose</subject><issn>0742-3071</issn><issn>1464-5491</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2017</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp1kMlOwzAQhi0EoqVw4AVQJC5wSOsti7mhEhapiAucLdcel1RZipNQ5e1xSeGAxFxmLH_6Z_QhdE7wlPiamRKmhLFEHKAx4TEPIy7IIRrjhNOQ4YSM0EnTrDEmVDBxjEY05UnCCRujLCvBraDSfdA6UG0JVRvUNnjvN_Wq6LWCMlc3gQpWXW6gyCsIVGUC-PSvSkPg_ATbU3RkVdHA2b5P0Nt99jp_DBcvD0_z20WoWcREaIWCZGmYYMQaoxSjOuLEgDaWLim2xDAeU2VjTXmKGbacU8oj_xuRKNWWTdDVkLtx9UcHTSvLvNFQFKqCumskSUWMWcL8tgm6_IOu685V_jpJxE4DpgJ76nqgtKubxoGVG5eXyvWSYLlzK71b-e3Wsxf7xG5Zgvklf2R6YDYA27yA_v8kefecDZFffEiCCQ</recordid><startdate>201709</startdate><enddate>201709</enddate><creator>Villani, M.</creator><creator>Courten, B.</creator><creator>Zoungas, S.</creator><general>Wiley Subscription Services, Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7T5</scope><scope>8FD</scope><scope>FR3</scope><scope>H94</scope><scope>K9.</scope><scope>P64</scope><scope>RC3</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-5388-5709</orcidid></search><sort><creationdate>201709</creationdate><title>Emergency treatment of hypoglycaemia: a guideline and evidence review</title><author>Villani, M. ; Courten, B. ; Zoungas, S.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3539-f9ae7bd3931fddaa32c541decdf2b20f1d3462af6c248030f442245df25158cf3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2017</creationdate><topic>Adult</topic><topic>Adults</topic><topic>Clinical trials</topic><topic>Dextrose</topic><topic>Diabetes</topic><topic>Diabetes mellitus</topic><topic>Diabetes Mellitus - blood</topic><topic>Diabetes Mellitus - drug therapy</topic><topic>Emergency Treatment - methods</topic><topic>Emergency Treatment - standards</topic><topic>Evidence-Based Practice</topic><topic>Glucagon</topic><topic>Humans</topic><topic>Hypoglycemia</topic><topic>Hypoglycemia - therapy</topic><topic>Hypoglycemic Agents - administration & dosage</topic><topic>Hypoglycemic Agents - adverse effects</topic><topic>Intravenous administration</topic><topic>Practice Guidelines as Topic - standards</topic><topic>Risk factors</topic><topic>Sucrose</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Villani, M.</creatorcontrib><creatorcontrib>Courten, B.</creatorcontrib><creatorcontrib>Zoungas, S.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Immunology Abstracts</collection><collection>Technology Research Database</collection><collection>Engineering Research Database</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>Genetics Abstracts</collection><collection>MEDLINE - Academic</collection><jtitle>Diabetic medicine</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Villani, M.</au><au>Courten, B.</au><au>Zoungas, S.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Emergency treatment of hypoglycaemia: a guideline and evidence review</atitle><jtitle>Diabetic medicine</jtitle><addtitle>Diabet Med</addtitle><date>2017-09</date><risdate>2017</risdate><volume>34</volume><issue>9</issue><spage>1205</spage><epage>1211</epage><pages>1205-1211</pages><issn>0742-3071</issn><eissn>1464-5491</eissn><abstract>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.</abstract><cop>England</cop><pub>Wiley Subscription Services, Inc</pub><pmid>28477413</pmid><doi>10.1111/dme.13379</doi><tpages>7</tpages><orcidid>https://orcid.org/0000-0002-5388-5709</orcidid></addata></record> |
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| ispartof | Diabetic medicine, 2017-09, Vol.34 (9), p.1205-1211 |
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| source | MEDLINE; Access via Wiley Online Library |
| subjects | Adult Adults Clinical trials Dextrose Diabetes Diabetes mellitus Diabetes Mellitus - blood Diabetes Mellitus - drug therapy Emergency Treatment - methods Emergency Treatment - standards Evidence-Based Practice Glucagon Humans Hypoglycemia Hypoglycemia - therapy Hypoglycemic Agents - administration & dosage Hypoglycemic Agents - adverse effects Intravenous administration Practice Guidelines as Topic - standards Risk factors Sucrose |
| title | Emergency treatment of hypoglycaemia: a guideline and evidence review |
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