title: Dietary sugars versus glucose tablets for first-aid treatment of symptomatic hypoglycaemia in awake patients with diabetes: a systematic review and meta-analysis.
abstract: BACKGROUND
  While glucose tablets have been advocated for treating symptomatic hypoglycaemia in awake patients, dietary sugars may be more convenient. We performed a systematic review to compare the impact of these treatment options on the relief of symptomatic hypoglycaemia, time to resolution of symptoms, blood glucose levels, complications and hospital length of stay.
  
  
  METHODS
  We searched PubMed, Embase and the Cochrane Library through 28 June 2016 and assessed the quality of evidence using the Grades of Recommendation, Assessment, Development and Evaluation approach. Reference lists from a subset of the resulting articles were mined for additional, potentially eligible papers. We calculated the risk ratio (RR) of each treatment option for the preselected outcomes of interest.
  
  
  RESULTS
  Of the 1774 identified papers, four studies met the inclusion criteria; three randomised controlled trials totalling 502 hypoglycaemic events treated with dietary sugars and 223 with glucose tablets and one observational study with 13 events treated with dietary sugars and 9 with glucose tablets. The dietary forms of sugar included sucrose, fructose, orange juice, jelly beans, Mentos, cornstarch hydrolysate, Skittles and milk. In the pooled analysis, patients treated with dietary sugars had a lower resolution of symptoms 15 min after treatment compared with glucose tablets (RR 0.89, 95% CI 0.83 to 0.95).
  
  
  CONCLUSIONS
  When compared with dietary sugars, glucose tablets result in a higher rate of relief of symptomatic hypoglycaemia 15 min after ingestion and should be considered first, if available, when treating symptomatic hypoglycaemia in awake patients.
authors.affiliation: Department of Emergency Medicine, Allegheny Health Network, Erie, Pennsylvania, USA.|Department of Emergency Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
authors.forename: Jestin N
authors.initials: JN
authors.lastname: Carlson
authors.affiliation: National Training Center, Austrian Red Cross, Vienna, AT, Austria.
authors.forename: Susanne
authors.initials: S
authors.lastname: Schunder-Tatzber
authors.affiliation: Li Ka Shing International Healthcare Education Centre at St Michael's Hospital, Toronto, Canada.
authors.forename: Christine J
authors.initials: CJ
authors.lastname: Neilson
authors.affiliation: Department of Emergency Medicine, Monash Health, Melbourne, Australia.
authors.forename: Natalie
authors.initials: N
authors.lastname: Hood
mesh_terms: D048909:Diabetes Complications / Q000188:drug therapy*; D019422:Dietary Sucrose / Q000008:administration & dosage / Q000627:therapeutic use*; D005392:First Aid; D005947:Glucose / Q000008:administration & dosage / Q000627:therapeutic use*; D006801:Humans; D007003:Hypoglycemia / Q000188:drug therapy*; D007902:Length of Stay / Q000706:statistics & numerical data; D013607:Tablets; D013997:Time Factors
chemical_list: D019422:Dietary Sucrose; D013607:Tablets; D005947:Glucose
keywords: metabolic/diabetes/endocrine