Treatment guidelines uniformly recommend to continue insulin sensitizers (biguanides and thiazolidinediones), but they recommend that insulin secretagogues be either discontinued from a regimen (14) or else continued in patients with close monitoring for hypoglycemic events (50).
The higher rate of self-monitored asymptomatic hypoglycemic events (8 vs. 2) might be biased due to the higher rate of glucose self-monitoring itself in the insulin glargine-treated patients.
This is a significant drawback considering many type 1 diabetes patients specifically purchase a continuous monitor for reductions in hypoglycemic events.
Key exclusion criteria were frequent or recent serious hypoglycemic events, unwillingness to monitor glucose at home or inject insulin, BMI greater than 45 kg/m, serum creatinine level greater than 1.5 mg/dL (133 μmol/L), or other serious illness.
Greater awareness and detection of all hypoglycemic events by careful monitoring, adherence to guidelines, and use of optimal treatment combinations is needed in order to prevent the serious medical and economic consequences associated with this adverse effect of antihyperglycemic medications.
In practice, this means an increase of the safety of the patient, especially during nighttime, when the patient is sleeping and an accurate continuous monitoring is needed to detect possible threatening hypoglycemic events.
During these visits we plan to monitor both clinical and adverse events, verify medication compliance and evaluate any hypoglycemic events.
We compared A1C, hypoglycemic events, and glucose variability from self-monitoring of blood glucose profiles at baseline and after 6 months of CSII.
During the RCT, we were able to determine the rate of severe hypoglycemic events in these subjects with optimized management with standard blood glucose monitoring (i.e., 27.7 events per 100 patient years).
Fourth, although we analyzed the association between the frequency of hypoglycemia and mortality, intermittent monitoring of BG in the present study may have led to undetected hypoglycemic events.
