Hypoglycemia is the limiting factor in the glycemic management of diabetes. It is a barrier to quality of life and even survival in the short term and to true glycemic control, with its established microvascular and potential macrovascular benefits, in the long term. Although it is possible to both improve glycemic control and minimize the risk of hypoglycemia in many patients with currently available regimens—by applying the principles of aggressive therapy and practicing hypoglycemia risk reduction—people with diabetes need treatment methods that provide glucose-regulated insulin secretion or replacement if euglycemia is to be maintained safely over a lifetime of diabetes.
Philip E. Cryer, MD, is the Irene E. and Michael M. Karl Professor of Endocrinology and Metabolism, and director of the Division of Endocrinology, Diabetes, and Metabolism and the General Clinical Research Center at Washington University in St. Louis, Mo. Belinda P. Childs, ARNP, MN, CDE, is a diabetes nurse specialist at MidAmerica Diabetes Associates in Wichita, Kans., and editor-in-chief of Diabetes Spectrum.
- American Diabetes Association