文摘

In patients with type?1 diabetes mellitus (T1DM) and type?2 diabetes mellitus (T2DM), hypoglycemia remains a relevant limiting factor in achieving the HbA1c target value. In addition to the acute emergency situation, hypoglycemia is of prognostic relevance for cardiovascular or cerebrovascular morbidity, which may also include mortality. Symptomatic and especially severe hypoglycemia are a burden not only for the affected patients, but they also represent a significant cost factor for the health care system. With the help of continuous glucose monitoring (CGM) the complex processes of perihypoglycemic episodes are better understood. CGM uncovered that besides obvious symptomatic hypoglycemia, a significant number of unrecognized hypoglycemia episodes occur, which are responsible for the high glucose variability and instability of glucose metabolism present in many patients. At risk are not only patients with T1DM, but also patients with long-standing T2DM under therapy with sulfonylureas or insulin. Another treatable risk factor is impaired counter-regulation with hypoglycemia unawareness. In addition to optimized management (training), the focus must be on hypoglycemia prevention by optimizing and avoiding potential triggers or risk factors. To achieve this, both individualized therapy goals and the choice of effective but safer therapeutic strategies regarding hypoglycemia risk are needed.