title: Medically minimising the impact of hypoglycaemia in type 2 diabetes: a review.
abstract: BACKGROUND
  Some therapies for type 2 diabetes (T2DM) are limited by hypoglycaemia, and this underestimated side effect carries an associated morbidity and financial burden. Large trials that have examined strict glycaemic control and cardiovascular outcomes in T2DM have highlighted the potential harm of exposure to hypoglycaemia in people with coronary heart disease.
  
  
  METHODS
  The responses to, and the morbidity associated with, hypoglycaemia in T2DM are discussed with identification of people most at risk of severe hypoglycaemia. The evidence base for non-pharmacological strategies and the risks of hypoglycaemia associated with various treatment modalities are examined. This review provides the clinician with a rational approach to the selection of different anti-diabetes drugs to minimize the risk of hypoglycaemia.
  
  
  CONCLUSIONS
  When managing T2DM, insulin and insulin secretagogues should be used judiciously and glycaemic targets individualized to avoid hypoglycaemia. Incretin mimetics present a lower risk of hypoglycaemia with similar efficacy as traditional agents in treating hyperglycaemia. The potential relationship between hypoglycaemia and precipitation of acute cardiovascular events is a highly topical area of research and may help determine what glycaemic targets are appropriate in people with T2DM.
authors.affiliation: Department of Diabetes, Royal Infirmary of Edinburgh, Edinburgh, EH16 4SA, UK.
authors.forename: Radzi M
authors.initials: RM
authors.lastname: Noh
authors.forename: Alex J
authors.initials: AJ
authors.lastname: Graveling
authors.forename: Brian M
authors.initials: BM
authors.lastname: Frier
mesh_terms: D001786:Blood Glucose / Q000032:analysis; D002986:Clinical Trials as Topic; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000188:drug therapy* / Q000453:epidemiology; D006801:Humans; D007003:Hypoglycemia / Q000097:blood / Q000139:chemically induced / Q000453:epidemiology / Q000517:prevention & control*; D007004:Hypoglycemic Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D007328:Insulin / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D010353:Patient Education as Topic; D012307:Risk Factors
chemical_list: D001786:Blood Glucose; D007004:Hypoglycemic Agents; D007328:Insulin