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Comment & Response
November 14, 2017

Insulin Analogues and Hypoglycemia in Patients With Type 1 Diabetes

Author Affiliations
  • 1Division of Endocrinology and Diabetes, Stadtspital Triemli, Zurich, Switzerland
  • 2University of Basel, Basel, Switzerland
JAMA. 2017;318(18):1828. doi:10.1001/jama.2017.14775

To the Editor The SWITCH 1 randomized clinical trial compared the effect of 2 insulin analogues, insulin degludec vs insulin glargine, on the frequency of hypoglycemic events in patients with type 1 diabetes and risk factors for hypoglycemia.1 According to the study protocol, the insulin dose was titrated to reach fasting glucose values between 71 mg/dL and 90 mg/dL (3.9-5.0 mmol/L). Such low target values increase the risk of severe hypoglycemia. The American Diabetes Association2 and National Institute for Health and Care Excellence3 in the United Kingdom recommend fasting glucose values that range from 90 mg/dL to 130 mg/dL. Also, professional diabetes organizations suggest less-stringent hemoglobin A1c (HbA1c) targets and, thus, higher target glucose values for patients at risk of severe hypoglycemia to prevent this complication.