Hypoglycemia in people with diabetes is a significant and challenging concern. To address this concern and understand the true impact of low blood glucose, however, requires a deeper understanding of the burden and severity of hypoglycemia, based on objective measures as well as subjective patient-reported events.

On Saturday, June 21, experts will review the evidence, share their insights, and engage in a robust debate on this topic in the session, What Is the Best Way to Measure the Burden and Severity of Hypoglycemia in People Living with Diabetes?, from at 3:15–4:15 p.m., in Room W185 A–D of the McCormick Place Convention Center.

“The current debate is focused on whether new continuous glucose monitoring (CGM) metrics, like time below range, are the most appropriate way to measure the burden of hypoglycemia, compared to estimating hypoglycemia burden based on hypoglycemia events,” said Gregg Simonson, PhD, Director of Strategy, Innovation, and Partnerships at the HealthPartners Institute International Diabetes Center. He will review evidence and present arguments in favor of time below range for this measurement.

Alexandria Ratzki-Leewing, PhD, MSc, Assistant Professor at the University of Maryland School of Medicine and the Institute for Health Computing, will discuss data that support the use of hypoglycemia events as the true measure of hypoglycemia burden.

“One of the tried-and-true aspects regarding hypoglycemia in individuals with diabetes is the definition of level 3, or severe, hypoglycemia, which requires assistance from another person, such as help administering carbohydrates or glucagon, admittance to a hospital for medical help, or emergency medical intervention,” Dr. Simonson said.

The American Diabetes Association^® (ADA) currently defines level 3 hypoglycemia as “a severe event characterized by altered mental and/or physical status requiring assistance for treatment of hypoglycemia, irrespective of glucose level.” Level 1 (measurable glucose concentration <70 mg/dL but ≥54 mg/dL) and level 2 (glucose <54 mg/dL) can be self-managed but also requires immediate attention.

Dr. Simonson noted that while there is consensus around the definition of level 3 hypoglycemia and avoidance of this serious complication, there are different ways to measure a hypoglycemia event, which adds to the complexity of using this metric to monitor hypoglycemia burden.

In the context of regulatory approvals of pharmacological interventions, CGM measurements of glucose <54 mg/dL for 15 minutes have been proposed as an indicator of hypoglycemia events, he explained. In other contexts, hypoglycemia is defined by glucose <70 mg/dL for 15 minutes.

“From a population health perspective, large cloud-based or electronic health record-based repositories can provide CGM data, including metrics such as time in range and time below range,” Dr. Simonson said. “These readily accessible metrics can help track the burden of and trends in hypoglycemia.”

Individuals with diabetes can view CGM metrics and enable alerts (via CGM apps) for imminent hypoglycemia risk.

“CGM-based metrics can serve as very effective tools for preventing hypoglycemia and can also spur conversation between the clinician and their patient, who may not be reporting/aware of their hypoglycemia,” Dr. Simonson noted, adding that there is evidence demonstrating time below range is predictive of severe hypoglycemia.

However, CGM metrics are objective measures that do not account for the patient’s experience of a hypoglycemia event. While time below range has many favorable attributes and can facilitate estimation of hypoglycemia burden, it is not the only way, Dr. Simonson noted. Eva Kathmann, PhD, Senior Patent Liaison at the Mayo Clinic, will address the patient perspective on how they measure and communicate hypoglycemia events and contextualize the evidence.

“This is an exciting and timely debate for contemporary diabetes management with implications for clinical practice,” Dr. Simonson said.

Following the debate, Eva Kathmann, PhD, Senior Patient Liaison at the Mayo Clinic, will discuss how patients can measure and communicate hypoglyceia events and experiences.

After the meeting, on-demand access to recorded presentations will be available to registered participants from June 25–August 25.