Diabetes currently affects over 425 million people worldwide. Hypoglycaemia is a common and serious complication of diabetes, particularly affecting people with diabetes on insulin treatment. It is characterised by abnormally low blood sugar levels, which can lead to cognitive impairment and in some severe cases, seizures, loss of consciousness, coma and even death.
Hypoglycaemia can be caused by too much insulin in the body, a low intake of carbohydrate, unplanned exercise and activities, and missed or delayed meals/snacks.
Typical symptoms include:
For people with diabetes, the generally accepted cut-off point to define hypoglycaemia is a blood glucose level below 3.9mmol/L (70 mg/dl), although people may experience symptoms associated with hypoglycaemia at a higher level or have no symptoms at that level.
Hypoglycaemia can have a profound effect on the everyday lives of people with diabetes and their carers. Research has found that 70% of people with type 1 diabetes feel tired the day after a night-time hypoglycaemic event and that over 60% of family members of people with diabetes are worried about the risk of hypoglycaemia to their loved one.
As much about hypoglycaemia remains unknown, the International Diabetes Federation (IDF) has joined the HypoResolve (Hypoglycaemia – Redefining SOLutions for better liVEs) consortium to help gain a better understanding of hypoglycaemia’s impact on the lives of people with diabetes and their carers and families, and ultimately improve their lives. HypoResolve comprises of 23 partners from nine European countries and the US, and includes leading academic experts, pharmaceutical and device manufacturers, as well as patient organisations.
HypoResolve aims to provide researchers and clinicians with more validated data about the condition by:
Creating a sustainable clinical database;
Conducting studies to better understand the underlying mechanisms of hypoglycaemia;
Conducting a series of statistical analyses to define predictors and consequences of hypoglycaemia;
Calculating the financial cost in European countries.
The project has an initial duration of 48 months and is divided into eight individual work packages:
Work package 1 deals with all aspects of project management to ensure all contractual commitments are met.
Work package 2 aims to identify the molecular/cellular and pathophysiological mechanisms and the consequences of hypoglycaemia through clinical and non-clinical studies.
Work package 3 will collate, harmonise and structure data from a range of clinical trial datasets for use by other work packages for statistical analysis.
Work package 4 aims to provide a classification of hypoglycaemia, beyond currently-used definitions, and to develop a standardised approach for the collection of clinical and laboratory data to be used primarily in clinical trials.
Work package 5 strives to understand the predictors and the impact of hypoglycaemia in terms of its biological and health-economic outcomes, and general outcomes for people living with diabetes.
Work package 6 aims to provide a comprehensive assessment of the impact of hypoglycaemia on the quality of life (QoL) of people with diabetes and their family members.
Work package 7 will assess the economic consequences of hypoglycaemia, the value of prevention and patient impact.
Work package 8 will engage with regulators and other stakeholders to develop a consensus guideline on agreed definitions of hypoglycaemia and data collection methods for the standardisation of clinical investigations.
HypoResolve consists of three advisory committees, including a Patient Advisory Committee (PAC), which inputs into all work packages and ensures that the insights, opinions and wishes of people with diabetes are taken into account across the multiple components of the project. The PAC is led jointly by IDF and the Juvenile Diabetes Research Foundation (JDRF), with Novo Nordisk acting as co-lead.
Current PAC Members include:
Mohammed Hamid, Morocco
Bastian Hauck, Germany
Simon O’Neil, UK
Rachel Portelli, Malta
Renza Scibilia, Australia
Phil Riley, Belgium
HypoResolve is supported with a grant of € 26.8 million from the Innovative Medicines Initiative (IMI), a joint undertaking of the European Commission and the European Federation of Pharmaceutical Industries and Associations (EFPIA), T1D Exchange, JDRF, IDF and the Leona M. and Harry B. Helmsley Charitable Trust.
People with diabetes have an increased risk of developing a number of serious health problems. Consistently high blood glucose levels can lead to serious diseases affecting the heart and blood vessels, eyes, kidneys, nerves and teeth. In addition, people with diabetes also have a higher risk of developing infections. In almost all high-income countries, diabetes is a leading cause of cardiovascular disease, blindness, kidney failure, and lower limb amputation.
Maintaining blood glucose levels, blood pressure, and cholesterol at or close to normal can help delay or prevent diabetes complications. Therefore people with diabetes need regular monitoring.
Cardiovascular disease: affects the heart and blood vessels and may cause fatal complications such as coronary artery disease (leading to heart attack) and stroke. Cardiovascular disease is the most common cause of death in people with diabetes. High blood pressure, high cholesterol, high blood glucose and other risk factors contribute to increasing the risk of cardiovascular complications. Learn more about diabetes and CVD.
Kidney disease (diabetic nephropathy): caused by damage to small blood vessels in the kidneys leading to the kidneys becoming less efficient or to fail altogether. Kidney disease is much more common in people with diabetes than in those without diabetes. Maintaining near normal levels of blood glucose and blood pressure can greatly reduce the risk of kidney disease.
Nerve disease (diabetic neuropathy): diabetes can cause damage to the nerves throughout the body when blood glucose and blood pressure are too high. This can lead to problems with digestion, erectile dysfunction, and many other functions. Among the most commonly affected areas are the extremities, in particular the feet. Nerve damage in these areas is called peripheral neuropathy, and can lead to pain, tingling, and loss of feeling. Loss of feeling is particularly important because it can allow injuries to go unnoticed, leading to serious infections and possible amputations. People with diabetes carry a risk of amputation that may be more than 25 times greater than that of people without diabetes. However, with comprehensive management, a large proportion of amputations related to diabetes can be prevented. Even when amputation takes place, the remaining leg and the person’s life can be saved by good follow-up care from a multidisciplinary foot team. People with diabetes should regularly examine their feet. Learn more about the diabetic foot.
Eye disease (diabetic retinopathy): most people with diabetes will develop some form of eye disease (retinopathy) causing reduced vision or blindness. Consistently high levels of blood glucose, together with high blood pressure and high cholesterol, are the main causes of retinopathy. It can be managed through regular eye checks and keeping glucose and lipid levels at or close to normal. Learn more about diabetes and the eye.
Pregnancy complications: Women with any type of diabetes during pregnancy risk a number of complications if they do not carefully monitor and manage their condition. To prevent possible organ damage to the fetus, women with type 1 diabetes or type 2 diabetes should achieve target glucose levels before conception. All women with diabetes during pregnancy, type 1, type 2 or gestational should strive for target blood glucose levels throughout to minimize complications. High blood glucose during pregnancy can lead to the foetus putting on excess weight. This can lead to problems in delivery, trauma to the child and mother, and a sudden drop in blood glucose for the child after birth. Children who are exposed for a long time to high blood glucose in the womb are at higher risk of developing diabetes in the future. Learn more about diabetes in pregnancy.
Oral complications: People with diabetes have an increased risk of inflammation of the gums (periodontitis) if blood glucose is not properly managed. Periodontitis is a major cause of tooth loss and is associated with an increased risk of cardiovascular disease (CVD). Regular oral check-ups should be established to ensure early diagnosis, particularly among people with previously undiagnosed diabetes and prompt management of any oral complications in people with diabetes. Annual visits are recommended for symptoms of gum disease such as bleeding when brushing teeth or swollen gums.
At present, type 1 diabetes cannot be prevented. The environmental triggers that are thought to generate the process that results in the destruction of the body’s insulin-producing cells are still under investigation.
While there are a number of factors that influence the development of type 2 diabetes, it is evident that the most influential are lifestyle behaviours commonly associated with urbanization. These include consumption of unhealthy foods and inactive lifestyles with sedentary behaviour. Randomised controlled trials from different parts of the world, including Finland, USA, China and India, have established the that lifestyle modification with physical activity and/or healthy diet can delay or prevent the onset of type 2 diabetes.
Modern lifestyles are characterised by physical inactivity and long sedentary periods. Community-based interventions can reach individuals and families through campaigns, education, social marketing and encourage physical activity both inside and outside school and the workplace. IDF recommends physical activity at least between three to five days a week, for a minimum of 30-45 minutes.
Taking a life course perspective is essential for preventing type 2 diabetes and its complications. Early in life, when eating and physical activity habits are established and when the long-term regulation of energy balance may be programmed, there is an especially critical window to prevent the development of overweight and reduce the risk of type 2 diabetes. Healthy lifestyles can improve health outcomes at later stages of life as well.
Population based interventions and policies allow healthy choices through policies in trade, agriculture, transport and urban planning to become more accessible and easy. Healthy choices can be promoted in specific settings (school, workplace and home) and contribute to better health for everyone. They include exercising regularly and eating wisely which will help to maintain normal levels of blood glucose, blood pressure and lipids.
IDF recommendations for a healthy diet for the general population
Choosing water, coffee or tea instead of fruit juice, soda, or other sugar sweetened beverages.
Eating at least three servings of vegetable every day, including green leafy vegetables.
Eating up to three servings of fresh fruit every day.
Choosing nuts, a piece of fresh fruit, or unsweetened yoghurt for a snack.
Limiting alcohol intake to a maximum of two standard drinks per day.
Choosing lean cuts of white meat, poultry or seafood instead of red or processed meat.
Choosing peanut butter instead of chocolate spread or jam.
Choosing whole-grain bread, rice, or pasta instead of white bread, rice, or pasta.
Choosing unsaturated fats (olive oil, canola oil, corn oil, or sunflower oil) instead of saturated fats (butter, ghee, animal fat, coconut oil or palm oil.
A particular threat in terms of the associated risk of developing type 2 diabetes is the consumption of high sugar foods, particularly sugar-sweetened beverages, In 2014, the World Health Organization (WHO) issued new recommendations to limit sugar intake. IDF fully supports these recommendations and in response published the IDF Framework for Action on Sugar.
The risk factors for type 1 diabetes are still being researched. However, having a family member with type 1 diabetes slightly increases the risk of developing the disease. Environmental factors and exposure to some viral infections have also been linked to the risk of developing type 1 diabetes.
Several risk factors have been associated with type 2 diabetes and include:
Family history of diabetes
High blood pressure
Impaired glucose tolerance (IGT)*
History of gestational diabetes
Poor nutrition during pregnancy
*Impaired glucose tolerance (IGT) is a category of higher than normal blood glucose, but below the threshold for diagnosing diabetes.
Changes in diet and physical activity related to rapid development and urbanisation have led to sharp increases in the numbers of people developing diabetes.
Pregnant women who are overweight, have been diagnosed with IGT, or have a family history of diabetes are all at increased risk of developing gestational diabetes mellitus (GDM). In addition, having been previously diagnosed with gestational diabetes or being of certain ethnic groups puts women at increased risk of developing GDM.
Know your risk of type 2 diabetes
Brief questionnaires are simple, practical and inexpensive ways to quickly identify people who may be at a higher risk of type 2 diabetes and who need to have their level of risk further investigated.
The Finnish Type 2 Diabetes Risk Assessment Form, developed in 2001, is an example of an effective questionnaire that can be used as the basis for developing national questionnaires which take into account local factors. It has eight scored questions, with the total test score providing a measure of the probability of developing type 2 diabetes over the following 10 years. The reverse of the form contains brief advice on what the respondent can do to lower their risk of developing the disease, and whether they should seek advice or have a clinical examination. The test takes only a couple of minutes to complete and can be done online, in pharmacies or at various public campaign events.
IDF has developed an IDF type 2 diabetes online diabetes risk assessment which aims to predict an individual’s risk of developing type 2 diabetes within the next ten years. The test is based on the Finnish Diabetes Risk Score (FINDRISC) developed and designed by Adj. Prof Jaana Lindstrom and Prof. Jaakko Tuomilehto from the National Institute for Health and Welfare, Helsinki, Finland. Click on the image below to take the test.