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Cited by 12Diabetes Management and ResearchDiabetes Management and EducationDiabetes Treatment and Management

Hypoglycemia in Adults

Open access
Lega, Iliana C., Yale, Jean-François, Chadha, Ayush, Paty, Breay, Roscoe, Rob, Snider, Melanie, Steier, Jennifer, Bajaj, Harpreet S. +11 more·2023·Canadian Journal of Diabetes
DOI 10.1016/j.jcjd.2023.08.003
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Integrity signals

Registry

Crossref · 10.1016/j.jcjd.2023.08.003

Cites

156 of 156 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

6 of 14 cited sources checked · 0 supported · 0 flagged · accuracy not yet measured

  • Premisecitation

    Fear of hypoglycemia may lead some individuals to target higher BG levels in an effort to avoid hypoglycemia, thereby worsening overall glycemic management.

    “This fear may lead some individuals to target higher BG levels in an effort to avoid hypoglycemia, thereby worsening overall glycemic management [8e10].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [8e10]

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • Premisecitation

    Iatrogenic hypoglycemia is a major obstacle to achieving glycemic targets in individuals with type 1 or type 2 diabetes mellitus treated with insulin and/or insulin secretagogues.

    “Iatrogenic hypoglycemia is a major obstacle to achieving glycemic targets in individuals with type 1 or type 2 diabetes mellitus treated with insulin and/or insulin secretagogues [1e3].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [1e3]

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • Premisecitation

    Hypoglycemia is often the primary barrier to achieving glycemic targets in individuals with type 1 diabetes.

    “Hypoglycemia is often the primary barrier to achieving glycemic targets in individuals with type 1 diabetes [16].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [16] Cryer, 1994, Banting Lecture. Hypoglycemia: The limiting factor in the management of IDDM, Diabetes source
  • May combine two claims. 4
  • Classified as probably not a substantial claim. 1

  • May combine two claims.

    Premisecitation

    Hypoglycemia is rare in individuals with type 2 diabetes who are not using insulin or insulin secretagogues, although it may still occur.

    “Hypoglycemia is rare in individuals with type 2 diabetes who are not using insulin or insulin secretagogues, although it may still occur [12,13].”
    Quote in the paperNot a substantial claim2 of 2 sources checked
    • cites [12] Danowitz, 2022, The role of GLP-1 signaling in hypoglycemia due to hyperinsulinism, Front Endocrinol (Lausanne) source

      The Incretin Physiology section (page unavailable) says incretin-enhancing therapies used for type 2 diabetes are not associated with overt hypoglycemia, while GLP-1 given with a sulfonylurea can cause it. That supports a narrower treatment-specific point, but the paper does not establish that hypoglycemia is rare across all people with type 2 diabetes who use neither insulin nor insulin secretagogues. (LLM, conf=0.78)

      Experimental — accuracy not yet measured
    • cites [13] Joseph, 2021, Symptomatic hypoglycemia during treatment with a therapeutic dose of metformin, Am J Case Rep source

      The Background and Discussion say that hypoglycemia at a therapeutic metformin dose is rare but possible, and describe a patient who reported no other diabetes treatment. They do not establish that hypoglycemia is rare across all people with type 2 diabetes who are not using insulin or insulin secretagogues; the evidence is specific to metformin treatment. (LLM, conf=0.84)

      Experimental — accuracy not yet measured

  • May combine two claims.

    Premisecitation

    Up to 65% of individuals with either type 1 or type 2 diabetes treated with insulin or insulin secretagogues self-report at least 1 episode of hypoglycemia in a given year, with a higher incidence in people with type 1 diabetes.

    “Hypoglycemia is very common; up to 65% of individuals with either type 1 or type 2 diabetes (treated with insulin or insulin secretagogues) self-report at least 1 episode of hypoglycemia in a given year, with a higher incidence in people with type 1 diabetes [11].”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [11] Ratzki-Leewing, 2018, Real-world crude incidence of hypoglycemia in adults with diabetes: Results of the InHypo-DM Study, Canada, BMJ Open Diabetes Res Care source

      The Frequency estimates section reports that 65.2% of the combined sample self-reported at least one event, and that the proportion was higher in type 1 diabetes (83.0%) than in type 2 (approximately 62.0%). But 65.2% is a pooled figure, not an upper bound for each diabetes type. The measure also combines non-severe events recalled over 30 days with severe events recalled over one year, rather than measuring all episodes over a year. (LLM, conf=0.88)

      Experimental — accuracy not yet measured

  • May combine two claims.

    Premisecitation

    The frequency and severity of hypoglycemia can negatively impact quality of life in individuals with diabetes and promote fear of future episodes of hypoglycemia.

    “The frequency and severity of hypoglycemia can negatively impact quality of life [4,5] in individuals with diabetes and promote fear of future episodes of hypoglycemia [6,7].”
    Quote in the paperSubstantial claim2 of 4 sources checked
    • cites [4] Alvarez-Guisasola, 2010, Association of hypoglycemic symptoms with patients’ rating of their health-related quality of life state: A cross sectional study, Health Qual Life Outcomes source

      The Results and Discussion (page not provided) link hypoglycemic symptoms and increasing symptom severity to lower quality-of-life ratings in European patients with type 2 diabetes receiving oral treatment. The paper does not establish that the frequency of episodes affects quality of life; it assessed whether patients recalled symptoms in the previous year. The fear-of-future-episodes clause has separate citations and is not attributed to this source. (LLM, conf=0.84)

      Experimental — accuracy not yet measured
    • cites [5] Chatwin, 2021, The impact of hypoglycaemia on quality of life outcomes among adults with type 1 diabetes: A systematic review, Diabetes Res Clin Pract source

      The Summary (p. 5) links severe and self-treated hypoglycaemia with greater fear, and section 1.3.2 (p. 14) reports one study linking severe episodes with lower diabetes-specific quality of life. But that section says the overall evidence does not show an association with diabetes-specific quality of life and is insufficient for generic quality of life. The review concerns adults with type 1 diabetes, not all individuals with diabetes, and does not establish that episode frequency worsens quality of life. (LLM, conf=0.86)

      Experimental — accuracy not yet measured
    • cites [6] Anderbro, 2010, Fear of hypoglycaemia in adults with type 1 diabetes, Diabet Med source
    • cites [7] Belendez, 2009, Beliefs about insulin as a predictor of fear of hypoglycaemia, Chronic Illn source

  • May combine two claims.

    Premisecitation

    The major risk factors for level 3 hypoglycemia include a prior episode of severe hypoglycemia, advancing age, low or high glycated hemoglobin (A1C), IAH, long duration of diabetes, autonomic neuropathy, adolescents and preschool-aged children unable to detect and/or treat mild hypoglycemia on their own, severe cognitive impairment, reduced health literacy, food insecurity, long duration of胰岛素治疗,

    “The major risk factors for level 3 hypoglycemia include a prior episode of severe hypoglycemia [17e19], advancing age [20], low or high glycated hemoglobin (A1C) [18,20e24], IAH [25,26], long duration of diabetes [22,27], autonomic neuropathy [28], adolescents [29] and preschool-aged children unable to detect and/or treat mild hypoglycemia on their own, severe cognitive impairment [30,31], reduced”
    Quote in the paperSubstantial claim1 of 3 sources checked
    • cites [17e19]

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

    • cites [20] Miller, 2010, The effects of baseline characteristics, glycaemia treatment approach, and glycated haemoglobin concentration on the risk of severe hypoglycaemia: Post hoc epidemiological analysis of the ACCORD study, BMJ source

      The Abstract reports increasing risk with age, and the ‘Absolute levels of haemoglobin A1C and hypoglycaemia risk’ section reports greater risk with higher A1C. The ‘Hypoglycaemia risk according to baseline subgroups’ section reports a larger intensive-versus-standard treatment hazard ratio at lower baseline A1C, but does not establish low A1C itself as a risk factor. Page numbers are unavailable in our copy. (LLM, conf=0.86)

      Experimental — accuracy not yet measured
    • cites [18,20e24]

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • Classified as probably not a substantial claim.

    Premisecitation

    The severity of hypoglycemia is characterized by the severity of the associated symptoms of hypoglycemia and risks, as defined by the International Hypoglycemia Study Group.

    “The severity of hypoglycemia is not strictly defined by glucose levels, but is characterized by the severity of the associated symptoms of hypoglycemia and risks, as defined by the International Hypoglycemia Study Group [14] (Tables 2 and 3).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [14] 2017, Glucose concentrations of less than 3.0 mmol/L (54 mg/dL) should be reported in clinical trials: A joint position statement of the American Diabetes Association and the European Association for the Study of Diabetes, Diabetes Care source
5 of 5

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • The common recommendation for hypoglycemia treatment (15 g simple carbohydrates, recheck in 15 min) was predominantly based on expert opinion and two small-sized studies of intravenous insulin-induced hypoglycemia in people living with type 1 diabetes mellitus.

    “Remarkably, this “15 grams/15 minutes” treatment is solely based on expert opinion, and two frequently-referenced, small-sized studies of intravenous insulin-induced hypoglycemia in people living with T1D [3–7].”

    From Systematic review of oral carbohydrate treatment for hypoglycemia in people living with type 2 diabetes mellitus (2026) · cites this paper as [5]

    Split into 2 atoms — 0 confirmed, 2 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.

    Experimental — accuracy not yet measured

  • The majority of non-severe hypoglycemia events are treated by the person living with diabetes with oral ingestion of simple carbohydrates to rapidly raise blood glucose levels.

    “The majority of non-severe hypoglycemia events are treated by the person living with diabetes with oral ingestion of simple carbohydrates to rapidly raise the blood glucose levels [3–5].”

    From Systematic review of oral carbohydrate treatment for hypoglycemia in people living with type 2 diabetes mellitus (2026) · cites this paper as [5]

    The “Level 1 or 2 hypoglycemia” section says these events are self-treatable and that oral glucose raises blood glucose within 20 minutes. The treatment recommendations advise people with level 1 or 2 hypoglycemia to ingest fast-acting carbohydrate. The paper does not establish that a majority of non-severe events are actually treated this way; page numbers were not available in our copy. (LLM, conf=0.86)

    Experimental — accuracy not yet measured

  • Most current guidelines recommend a glucose threshold below 3.9 or 4.0 mmol/L as requiring prompt treatment, especially when insulin or sulfonylurea is active in the body.

    “However, most current guidelines recommend a glucose threshold of below 3.9 or 4.0 mmol/L as requiring prompt treatment, especially when insulin or sulfonylurea is active in the body [3–5].”

    From Systematic review of oral carbohydrate treatment for hypoglycemia in people living with type 2 diabetes mellitus (2026) · cites this paper as [5]

    The treatment recommendations (page unavailable) call for prompt treatment of level 1 and 2 hypoglycemia and retreatment if glucose remains below 3.9 mmol/L. The guideline also identifies insulin and sulfonylureas as causes of hypoglycemia. It does not establish that most current guidelines use this threshold or document a 4.0 mmol/L threshold. (LLM, conf=0.82)

    Experimental — accuracy not yet measured

  • Lack of timely treatment of Level 1 hypoglycemia leads to Level 2 hypoglycemia.

    “Lack to timely treatment will then lead to Level 2 hypoglycemia (glucose below 3.0 mmol/L), also known as moderate hypoglycemia, when the person living with diabetes experiences neuroglycopenic symptoms such as confusion, drowsiness, slurred speech, and weakness [3–5].”

    From Systematic review of oral carbohydrate treatment for hypoglycemia in people living with type 2 diabetes mellitus (2026) · cites this paper as [5]

    The Treatment of Hypoglycemia section says hypoglycemia should be treated immediately, and Table 2 classifies level 2 as glucose below 3.0 mmol/L with neuroglycopenic symptoms (page not provided). The paper does not say that failing to treat level 1 promptly will necessarily lead to level 2. (LLM, conf=0.83)

    Experimental — accuracy not yet measured

  • The 15 g/15 min recommendation has been widespread in clinical guidelines for the past few decades and has been suggested for both people living with T2D and type 1 diabetes mellitus.

    “This recommendation has been widespread in clinical guidelines for the past few decades and has been suggested for both people living with T2D and type 1 diabetes mellitus (T1D) [3–5].”

    From Systematic review of oral carbohydrate treatment for hypoglycemia in people living with type 2 diabetes mellitus (2026) · cites this paper as [5]

    The guideline’s Treatment of hypoglycemia recommendation advises 15 g of fast-acting carbohydrate and retesting after 15 minutes for individuals with diabetes, supporting its application to both type 1 and type 2 diabetes. The passages do not establish that the recommendation has been widespread across clinical guidelines for the past few decades. (LLM, conf=0.85)

    Experimental — accuracy not yet measured

Cites

Flagged first, then by citations

Research works printed but not linked: 3

  1. Lega, 2021, Potential diabetes overtreatment and risk of adverse events among older adults in Ontario: A population-based study, Diabetologia, 64, 1093, 10.1007/s00125-020-05370-7 · DOI · Paper page
  2. Kinsley, 1999, Blood glucose awareness training and epinephrine responses to hypoglycemia during intensive treatment in type 1 diabetes, Diabetes Care, 22, 1022, 10.2337/diacare.22.7.1022 · DOI · Paper page
  3. 1991, The role of dietary sugars in diabetes mellitus, Beta Release, 15, 117

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Authors
Lega, I. C., Yale, J.-F., Chadha, A., Paty, B., Roscoe, R., Snider, M., Steier, J., Bajaj, H. S., Barnes, T., Gilbert, J., Honshorst, K., Kim, J., Lewis, J., MacDonald, B., MacKay, D., Mansell, K., Senior, P., Rabi, D., & Sherifali, D.
ORCID
Venue
Canadian Journal of Diabetes
Publisher
Elsevier BV
Published
2023-10
Volume
47
Issue
7
Pages
548-559
ISSN
1499-2671 (ISSN-L)
DOI
10.1016/j.jcjd.2023.08.003
OpenAlex
W4387499806
Semantic Scholar
0764170e9b102ee345f9fd8b8bce0f0b9de26e4c
Cited by
12
References
147
Citations by year
2026: 4 · 2025: 5 · 2024: 3
FWCI
1.98
Type
journal article
Language
en
Open access
Licence
Locations
  • Canadian Journal of Diabetes (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Education
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
Keywords
hypoglycemia, diabetes mellitus, insulin, insulin secretagogues, sulfonylureas, meglitinides, impaired awareness of hypoglycemia, fear of hypoglycemia, glucagon, continuous glucose monitoring, hypoglycemia prevention, hypoglycemia treatment, type 1 diabetes, type 2 diabetes, hypoglycemia education
MeSH terms
Adult, Blood Glucose, Diabetes Mellitus, Type 1, Humans, Hypoglycemia, Hypoglycemic Agents

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