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Attitudes and opinions of clinicians toward severe hypoglycemia and its management

AIM Purpose of the survey was to investigate the attitudes of diabetologists with respect to the issue of severe hypoglycemia. MATERIALS AND METHODS A 29-item survey was distributed via the web. The first part of the questionnaire was aimed at describing the sample of clinicians involved (age, gender, specialty, practice setting, etc.). The second part analyzed the perception of “hypoglycemia” as an issue, the management of episodes, educational interventions, the expected possibilities for improvement. One hundred and sixty-five clinicians participated in the survey, mostly diabetologists (81.5% of the sample), with long experience in the field (over 73% have been working as diabetologists for more than 15 years). RESULTS More than 77% of participants claimed to collect information about severe hypoglycemia episodes on electronic records, especially for patients with type1 diabetes (DM1), less frequently for type 2 diabetes (DM2). Hypoglycemia unawareness is still the main concern both for clinicians and for the patients, and repeated educational interventions are the main response strategy. However, the use of validated questionnaires to investigate hypoglycemia is still not widespread. The prescription of glucagon is generally reserved to patients with DM1 only (32.1% of participants), for any patient treated with insulin, regardless of the type of diabetes (29.7% of participants), and for any patient treated with drugs potentially at risk of hypoglycemia (17.6%). Seventeen percent of clinicians prescribe glucagon only to patients with DM1 with previous episodes of severe hypoglycemia. On a 0 to 10 scale, the most important measures to improve the management of severe hypoglycemia are considered: availability of drugs with low risk of hypoglycemia (average value 8.9), increased awareness of risk factors (average value 8.8), use of systems for continuous monitoring of blood glucose (average value 8.5), the availability of easier-to-administer glucagon formulations and the increased availability (average value 8.3) of educational material (average value 7.4). Most of the physicians participating in the survey were also aware of the economic problem related to hypoglycemia. CONCLUSIONS Hypoglycemia represents a relevant clinical problem for the management of patients with diabetes, of which clinicians are well aware and with respect to which therapeutic, educational and management improvements are desirable for the reduction of events and associated costs. KEY WORDS hypoglycemia; clinical records; glucagon; education; survey.