title: Update on strategies limiting iatrogenic hypoglycemia.
abstract: The prevalence of type 2 diabetes mellitus (T2DM) is increasing all over the world. Targeting good glycemic control is fundamental to avoid the complications of diabetes linked to hyperglycemia. This narrative review is based on material searched for and obtained via PubMed up to April 2015. The search terms we used were: 'hypoglycemia, diabetes, complications' in combination with 'iatrogenic, treatment, symptoms.' Serious complications might occur from an inappropriate treatment of hyperglycemia. The most frequent complication is iatrogenic hypoglycemia that is often associated with autonomic and neuroglycopenic symptoms. Furthermore, hypoglycemia causes acute cardiovascular effects, which may explain some of the typical symptoms: ischemia, QT prolongation, and arrhythmia. With regards to the latter, the night represents a dangerous period because of the major increase in arrhythmias and the prolonged period of hypoglycemia; indeed, sleep has been shown to blunt the sympatho-adrenal response to hypoglycemia. Two main strategies have been implemented to reduce these effects: monitoring blood glucose values and individualized HbA1c goals. Several drugs for the treatment of T2DM are currently available and different combinations have been recommended to achieve individualized glycemic targets, considering age, comorbidities, disease duration, and life expectancy. In conclusion, according to international guidelines, hypoglycemia-avoiding therapy must reach an individualized glycemic goal, which is the lowest HbA1c not causing severe hypoglycemia and preserving awareness of hypoglycemia.
authors.affiliation: Department of Internal MedicineFirst Clinic of Internal Medicine, University of Genoa School of Medicine, IRCCS Azienda Ospedaliera Universitaria San Martino - IST Istituto Nazionale per la Ricerca sul Cancro, Genoa, ItalyDivision of CardiologyFoundation for Medical Researches, Department of Medical Specialties, University of Geneva, Geneva, SwitzerlandDivision of Laboratory MedicineDepartment of Genetics and Laboratory Medicine, Geneva University Hospitals, 4 rue Gabrielle-Perret-Gentil, Avenue de la Roseraie 64, 1205 Geneva, Switzerland.
authors.forename: Aldo
authors.initials: A
authors.lastname: Bonaventura
authors.affiliation: Department of Internal MedicineFirst Clinic of Internal Medicine, University of Genoa School of Medicine, IRCCS Azienda Ospedaliera Universitaria San Martino - IST Istituto Nazionale per la Ricerca sul Cancro, Genoa, ItalyDivision of CardiologyFoundation for Medical Researches, Department of Medical Specialties, University of Geneva, Geneva, SwitzerlandDivision of Laboratory MedicineDepartment of Genetics and Laboratory Medicine, Geneva University Hospitals, 4 rue Gabrielle-Perret-Gentil, Avenue de la Roseraie 64, 1205 Geneva, Switzerland Department of Internal MedicineFirst Clinic of Internal Medicine, University of Genoa School of Medicine, IRCCS Azienda Ospedaliera Universitaria San Martino - IST Istituto Nazionale per la Ricerca sul Cancro, Genoa, ItalyDivision of CardiologyFoundation for Medical Researches, Department of Medical Specialties, University of Geneva, Geneva, SwitzerlandDivision of Laboratory MedicineDepartment of Genetics and Laboratory Medicine, Geneva University Hospitals, 4 rue Gabrielle-Perret-Gentil, Avenue de la Roseraie 64, 1205 Geneva, Switzerland Department of Internal MedicineFirst Clinic of Internal Medicine, University of Genoa School of Medicine, IRCCS Azienda Ospedaliera Universitaria San Martino - IST Istituto Nazionale per la Ricerca sul Cancro, Genoa, ItalyDivision of CardiologyFoundation for Medical Researches, Department of Medical Specialties, University of Geneva, Geneva, SwitzerlandDivision of Laboratory MedicineDepartment of Genetics and Laboratory Medicine, Geneva University Hospitals, 4 rue Gabrielle-Perret-Gentil, Avenue de la Roseraie 64, 1205 Geneva, Switzerland fabrizio.montecucco@unige.ch.
authors.forename: Fabrizio
authors.initials: F
authors.lastname: Montecucco
authors.affiliation: Department of Internal MedicineFirst Clinic of Internal Medicine, University of Genoa School of Medicine, IRCCS Azienda Ospedaliera Universitaria San Martino - IST Istituto Nazionale per la Ricerca sul Cancro, Genoa, ItalyDivision of CardiologyFoundation for Medical Researches, Department of Medical Specialties, University of Geneva, Geneva, SwitzerlandDivision of Laboratory MedicineDepartment of Genetics and Laboratory Medicine, Geneva University Hospitals, 4 rue Gabrielle-Perret-Gentil, Avenue de la Roseraie 64, 1205 Geneva, Switzerland.
authors.forename: Franco
authors.initials: F
authors.lastname: Dallegri
keywords: diabetes treatment; glycemic control; hypoglycemia; incretins; insulin therapy