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Despite therapeutic advances, prevention and management of hypoglycemia still susceptible to ‘thinking traps’


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3 minutes

Technological advances and improved therapies are paving the way for new approaches in the prevention and management of hypoglycemia. However, these advances bring challenges that will be addressed during the session The Pros and Cons of New Approaches to Prevent and Manage Hypoglycemia in Diabetes Therapies, which will begin at 1:45 p.m. ET on Saturday, June 26.

During the two-hour presentation, Jennifer Sherr, MD, PhD, Associate Professor of Pediatrics (Endocrinology) at Yale University School of Medicine, will discuss the development of new “game-changing” glucagon formulations for the treatment of severe hypoglycemia.

Jennifer Sherr, MD, PhD
Jennifer Sherr, MD, PhD

“For many years, glucagon therapy has been a somewhat neglected part of diabetes therapy,” Dr. Sherr said. “Insulin therapy has seen vast innovation—lots of new basal insulins, new rapid-acting analogs—but for quite a long time, we’ve had only the singular commercially available glucagon kits, which require a lot in terms of reconstitution prior to administration, and that often scared people.”

That all changed in 2019 with the approval of a nasally administered glucagon formulation and liquid stable formulations.

“We finally have better tools, and I think that allows us to now educate persons with diabetes, their families, and other individuals who touch their lives that these therapies are effective and easier to administer,” Dr. Sherr said. “We need to make sure that people have access to them and know how to use them if an event should occur.”

Having a conversation about severe hypoglycemia with diabetes patients is something that has often been overlooked or avoided, but needs to be discussed during routine follow-up visits, she said.

“I think persons with diabetes want to be asked but are concerned about the potential judgment that can surround their feeling that they have failed with their insulin therapies should a severe hypoglycemic event occur. They need to know it’s OK to tell us about it, and we should open that conversation,” Dr. Sherr said. “We recognize it’s a complication that can occur with insulin therapy, and learning about whether they’ve experienced it can help us tailor their regimens. We, as providers, need to make sure that each insulin-requiring person with diabetes we see is asked about episodes of severe hypoglycemia and is provided with the treatment necessary should an event occur.”

Nicole de Zoysa, DClinPsych
Nicole de Zoysa, DClinPsych

Expanding on that idea, Nicole de Zoysa, DClinPsych, Senior Clinical Psychologist, Diabetes Research, at Kings College Hospital NHS Foundation Trust in London, United Kingdom, will discuss how overcoming psychological obstacles is one of the keys to optimal hypoglycemia management.

“Frequent hypoglycemia is a physiological and psychosocial stressor that we should be aiming to reduce. It can produce significant anxiety, not just for the person with diabetes, but also their families and their health care team,” Dr. de Zoysa said. “Technology is a great asset to reducing hypoglycemia, but the mindset of the end user is also key to ensure optimal engagement.”

Dr. de Zoysa will review some of the common “thinking traps” that may prevent people from responding to low blood glucose levels consistently and in a timely fashion, and how diabetes professionals can start to identify and manage the cognitive barriers to reducing hypoglycemia.

“This is an important topic right now because, although hypoglycemia burden is greatly reduced through advancing technology, the question remains: How do we optimize this ‘algorithm medicine’ when it can still be overridden by an emotional brain?” Dr. de Zoysa said.

Also during this session, Danny Hung-Chieh Chou, PhD, Assistant Professor of Pediatrics (Endocrinology and Diabetes) at Stanford University, will discuss how smart insulins can reduce hypoglycemia risk, and Steven J. Russell, MD, PhD, Associate Professor of Medicine at Massachusetts General Hospital and Harvard Medical School, will review the limitations of hybrid closed-loop insulin delivery systems in hypoglycemia avoidance.


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