Hypoglycemia in the Diabetic Patient: The Controversy in its Study, in Search of its Implications
Autor(a) principal: | |
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Data de Publicação: | 2013 |
Outros Autores: | , |
Tipo de documento: | Artigo |
Idioma: | por |
Título da fonte: | Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) |
Texto Completo: | https://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/1365 |
Resumo: | Hypoglycemia is one of the greatest limitations regarding the treatment of diabetes, as well as one of the most expensive. Its relevancegoes beyond the episode itself or the rare sequel. The occurrence of hypoglycemia is frequently followed by treatment adjustmentsinvolving the glycemic target, which can result in long term diabetes complications. Its medium and long term consequences are notyet understood in light of recent studies, which have renewed fears regarding an increased cardiovascular risk with its occurrence.Controversy around its definition, as well as serious methodological limitations, led to disparities between the results of the multiplestudies of incidence and costs. The low adhesion of a significant number of diabetic patients to glycemic self-monitoring during symptomaticepisodes leads to diagnostic uncertainty and, occasionally, to a worsening of the glycemic control. The health-care based studiesresult in great underestimation of its incidence given the fact that many episodes are mild in nature, and some severe hypoglycemicepisodes are treated by the patient´s family or friends. Recent studies revealed that a significant number of severe hypoglycemic episodestreated by health-care professionals doesn´t involve transportation to an Emergency Department. The same data suggest thatthe largest portion of the direct and indirect costs of diabetic hypoglycemia is related to the episodes that are treated at the Hospital,particularly if the patient is admitted in the ward.In the past decades a great investment has been made in the development of multiple strategies for the avoidance of hypoglycemia,namely the continuous blood glucose monitoring devices, as well as new drugs. In spite of the efforts, hypoglycemia remains as one ofthe most important problems in the treatment of diabetes. |
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Hypoglycemia in the Diabetic Patient: The Controversy in its Study, in Search of its ImplicationsA Hipoglicemia no Diabético: Controvérsia na Avaliação, à Procura das suas ImplicaçõesHypoglycemia is one of the greatest limitations regarding the treatment of diabetes, as well as one of the most expensive. Its relevancegoes beyond the episode itself or the rare sequel. The occurrence of hypoglycemia is frequently followed by treatment adjustmentsinvolving the glycemic target, which can result in long term diabetes complications. Its medium and long term consequences are notyet understood in light of recent studies, which have renewed fears regarding an increased cardiovascular risk with its occurrence.Controversy around its definition, as well as serious methodological limitations, led to disparities between the results of the multiplestudies of incidence and costs. The low adhesion of a significant number of diabetic patients to glycemic self-monitoring during symptomaticepisodes leads to diagnostic uncertainty and, occasionally, to a worsening of the glycemic control. The health-care based studiesresult in great underestimation of its incidence given the fact that many episodes are mild in nature, and some severe hypoglycemicepisodes are treated by the patient´s family or friends. Recent studies revealed that a significant number of severe hypoglycemic episodestreated by health-care professionals doesn´t involve transportation to an Emergency Department. The same data suggest thatthe largest portion of the direct and indirect costs of diabetic hypoglycemia is related to the episodes that are treated at the Hospital,particularly if the patient is admitted in the ward.In the past decades a great investment has been made in the development of multiple strategies for the avoidance of hypoglycemia,namely the continuous blood glucose monitoring devices, as well as new drugs. In spite of the efforts, hypoglycemia remains as one ofthe most important problems in the treatment of diabetes.A hipoglicemia é uma das principais limitações ao tratamento atual da diabetes, assim como uma complicação aguda dispendiosa. Assuas consequências não se limitam ao episódio de hipoglicemia, nem às infrequentes sequelas objectiváveis. A ocorrência de hipoglicemiaé frequentemente acompanhada por um descalamento das estratégias de tratamento da diabetes, com o risco subsequente dedesenvolver complicações crónicas. Adicionalmente, as suas consequências a médio e longo prazo ainda não estão esclarecidas à luzde estudos recentes, que renovaram o receio do aumento da mortalidade cardiovascular com a sua ocorrência.A controvérsia à volta da sua definição, assim como graves limitações metodológicas, conduziu a grandes disparidades nos resultadosdos estudos de incidência e custos. A baixa adesão de um número significativo de diabéticos à auto-vigilância glicémica nos momentossintomáticos conduz a grande incerteza diagnóstica e, ocasionalmente, agravamento do controlo glicémico. Os estudos baseados nosserviços de saúde resultam em grande subestimação da incidência de hipoglicemia, uma vez que muitos dos episódios são ligeiros, eum número significativo dos episódios graves são tratados pelos familiares ou amigos do diabético. Estudos recentes revelaram queuma percentagem significativa dos diabéticos tratados por profissionais de saúde é tratada no domicílio, sem ser observada no Serviçode Urgência. Os mesmos dados sugerem que a maior parte dos custos directos e indirectos da hipoglicemia no diabético refere-se aosepisódios observados em contexto hospitalar, particularmente se resultarem em internamento.Nos últimos anos tem-se assistido ao investimento em múltiplas estratégias de evicção da hipoglicemia, nomeadamente da monitorizaçãocontínua da glicose intersticial, assim como o uso de novos fármacos. Apesar dos esforços, a hipoglicemia permanece umproblema incontornável no tratamento da diabetes.Ordem dos Médicos2013-01-28info:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/articleapplication/x-pdfhttps://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/1365oai:ojs.www.actamedicaportuguesa.com:article/1365Acta Médica Portuguesa; Vol. 25 No. 6 (2012): November-December; 454-460Acta Médica Portuguesa; Vol. 25 N.º 6 (2012): Novembro-Dezembro; 454-4601646-07580870-399Xreponame:Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)instname:Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informaçãoinstacron:RCAAPporhttps://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/1365https://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/1365/957Esteves, CésarNeves, CelestinoCarvalho, Davideinfo:eu-repo/semantics/openAccess2022-12-20T10:57:47Zoai:ojs.www.actamedicaportuguesa.com:article/1365Portal AgregadorONGhttps://www.rcaap.pt/oai/openaireopendoar:71602024-03-19T16:17:05.651988Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) - Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informaçãofalse |
dc.title.none.fl_str_mv |
Hypoglycemia in the Diabetic Patient: The Controversy in its Study, in Search of its Implications A Hipoglicemia no Diabético: Controvérsia na Avaliação, à Procura das suas Implicações |
title |
Hypoglycemia in the Diabetic Patient: The Controversy in its Study, in Search of its Implications |
spellingShingle |
Hypoglycemia in the Diabetic Patient: The Controversy in its Study, in Search of its Implications Esteves, César |
title_short |
Hypoglycemia in the Diabetic Patient: The Controversy in its Study, in Search of its Implications |
title_full |
Hypoglycemia in the Diabetic Patient: The Controversy in its Study, in Search of its Implications |
title_fullStr |
Hypoglycemia in the Diabetic Patient: The Controversy in its Study, in Search of its Implications |
title_full_unstemmed |
Hypoglycemia in the Diabetic Patient: The Controversy in its Study, in Search of its Implications |
title_sort |
Hypoglycemia in the Diabetic Patient: The Controversy in its Study, in Search of its Implications |
author |
Esteves, César |
author_facet |
Esteves, César Neves, Celestino Carvalho, Davide |
author_role |
author |
author2 |
Neves, Celestino Carvalho, Davide |
author2_role |
author author |
dc.contributor.author.fl_str_mv |
Esteves, César Neves, Celestino Carvalho, Davide |
description |
Hypoglycemia is one of the greatest limitations regarding the treatment of diabetes, as well as one of the most expensive. Its relevancegoes beyond the episode itself or the rare sequel. The occurrence of hypoglycemia is frequently followed by treatment adjustmentsinvolving the glycemic target, which can result in long term diabetes complications. Its medium and long term consequences are notyet understood in light of recent studies, which have renewed fears regarding an increased cardiovascular risk with its occurrence.Controversy around its definition, as well as serious methodological limitations, led to disparities between the results of the multiplestudies of incidence and costs. The low adhesion of a significant number of diabetic patients to glycemic self-monitoring during symptomaticepisodes leads to diagnostic uncertainty and, occasionally, to a worsening of the glycemic control. The health-care based studiesresult in great underestimation of its incidence given the fact that many episodes are mild in nature, and some severe hypoglycemicepisodes are treated by the patient´s family or friends. Recent studies revealed that a significant number of severe hypoglycemic episodestreated by health-care professionals doesn´t involve transportation to an Emergency Department. The same data suggest thatthe largest portion of the direct and indirect costs of diabetic hypoglycemia is related to the episodes that are treated at the Hospital,particularly if the patient is admitted in the ward.In the past decades a great investment has been made in the development of multiple strategies for the avoidance of hypoglycemia,namely the continuous blood glucose monitoring devices, as well as new drugs. In spite of the efforts, hypoglycemia remains as one ofthe most important problems in the treatment of diabetes. |
publishDate |
2013 |
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2013-01-28 |
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https://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/1365 |
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https://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/1365 https://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/1365/957 |
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Ordem dos Médicos |
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Ordem dos Médicos |
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Acta Médica Portuguesa; Vol. 25 No. 6 (2012): November-December; 454-460 Acta Médica Portuguesa; Vol. 25 N.º 6 (2012): Novembro-Dezembro; 454-460 1646-0758 0870-399X reponame:Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) instname:Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação instacron:RCAAP |
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