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Predicting severe hypoglycemia in the community: a review of recent evidence

Wendy A Davis

The recent literature relating to predictors of severe hypoglycemia in the community is reviewed. Medline and EMBASE databases were searched for English language papers between 2005 and July 2010 using the terms (‘severe hypoglyc[a]emia’ or ‘symptomatic hypoglyc[a]emia’) and (‘predictor[s]’ or ‘predict[s]’ or ‘prediction’, ‘determinant[s]’ or ‘determine[s]’ or ‘marker[s]’ or ‘factor[s]’ or ‘indicator[s]’). All studies meeting the inclusion criteria were included. From 186 papers identified, 13 original studies were considered eligible. Another eligible paper became available online during the review process. Of the 14 studies, six were studies of Type 2 diabetes. Two or more of these studies recognized dementia or severe cognitive impairment, higher HbA1c, low BMI and peripheral neuropathy as predictors of severe hypoglycemia in adults with Type 2 diabetes. Renin–angiotensin system-related risk factors independently predicted the frequency of severe hypoglycemia in adults, but not children or adolescents with Type 1 diabetes. An algorithm derived from self-monitoring of blood glucose data predicted imminent severe hypoglycemia in insulin-using diabetic patients.