Q&A: Anthony L. McCall, MD, PhD, FACP, and David C. Lieb, MD, FACP

Endocrine News talks with Anthony L. McCall, MD, PhD, FACP and David C. Lieb, MD, FACP, co–chairs of the guideline development panel that created the latest Endocrine Society Clinical Practice Guideline on managing hypoglycemia in people with diabetes.

In the last decade or so, the amount of progress made in treating people with hypoglycemia has been nothing short of remarkable. Because of these developments, the Endocrine Society is updating one of its earlier guidelines on managing hypoglycemia. However, this new guideline is solely focused on managing hypoglycemia in people with diabetes.

The new guideline, “Management of Individuals with Diabetes at High Risk for Hypoglycemia: An Endocrine Society Clinical Practice Guideline,” will be published online in December and will appear in the December 2022 print issue of The Journal of Clinical Endocrinology & Metabolism. This guideline updates a previous guideline from 2009, “Evaluation and Management of Adult Hypoglycemic Disorders: An Endocrine Society Clinical Practice Guideline. However, that guideline included both people with and without diabetes whereas this latest version is only for treating those people who have diabetes as well as hypoglycemia.

Anthony L. McCall, MD, PhD, FACP, professor of medicine and endocrinology (Emeritus)  University of Virginia School of Medicine; and David C. Lieb, MD, FACP, the Aaron I. Vinik Professor of Medicine in Endocrinology and Diabetes; associate chair for education, Department of Internal Medicine; and program director, Endocrinology, Diabetes and Metabolism Fellowship at Eastern Virginia Medical School in Norfolk, Va., are the co-chairs of the guideline development panel that authored the guideline.

“Hypoglycemia affects everyone living with diabetes, and it remains the major barrier for safe diabetes control in many people. This guideline will give updated, evidence-based recommendations involving the prevention and management of hypoglycemia to those in healthcare who provide diabetes-related services.”

David C. Lieb, MD, FACP, the Aaron I. Vinik Professor of Medicine in Endocrinology and Diabetes; Associate Chair for Education, Department of Internal Medicine; and Program Director, Endocrinology, Diabetes and Metabolism Fellowship, Eastern Virginia Medical School, Norfolk, Va.

McCall and Lieb shared their thoughts with Endocrine News about how they hope this guideline will provide the latest in evidence-based recommendations for treatment and how it should be a valuable tool for primary care physicians and other practitioners.

Endocrine News: What was the main reason for the publication of the hypoglycemia guideline – what drove the decision and why now?

Anthony L. McCall, MD, PhD: In the last decade we have seen dramatic changes in the management of hypoglycemia in persons with diabetes. Available technology allowing for the identification of, and prevention of hypoglycemia has improved significantly, with more accurate continuous glucose monitoring devices that can identify both symptomatic and unrecognized hypoglycemia, and new sensor-augmented insulin pumps. There are effective and easier-to-use formulations of glucagon as well, and new analog insulins preparations that are associated with less hypoglycemia. Finally, there are new and better systems for reducing inpatient hypoglycemia, and updated information involving hypoglycemia reduction through outpatient education programs. The previous Endocrine Society Clinical Practice Guideline from 2009 included both those with diabetes and those without diabetes. Given all of these pertinent updates, it was important to develop a guideline focused on those with diabetes at risk for hypoglycemia.

EN: What are your hopes for the impact of the guideline on endocrine standards of care for individuals with diabetes at high risk for hypoglycemia?

David C. Lieb, MD: Hypoglycemia affects everyone living with diabetes, and it remains the major barrier for safe diabetes control in many people. This guideline will give updated, evidence-based recommendations involving the prevention and management of hypoglycemia to those in healthcare who provide diabetes-related services. Both people with diabetes and their caregivers and diabetes specialists will benefit from a better understanding of best practices, including what works well and how much benefit can be expected from various interventions.

EN: How do you expect other medical specialties to be affected by the Guideline Development Panel’s recommendations?

ALM: Diabetes affects over 400 million people worldwide, and many, if not all, of these individuals either deal with or have concerns about hypoglycemia. Most persons with diabetes do not see an endocrinologist but have many other healthcare providers. Therefore, it’s important that all of those who care for individuals with diabetes, including those in primary care specialties, surgical specialties, and mental health have a strong medical knowledge in both how to prevent and how to manage hypoglycemia. This of course includes all clinicians – including nurse practitioners, physician associates, diabetes care and education specialists, physicians and others.

Most persons with diabetes do not see an endocrinologist but have many other healthcare providers. Therefore, it’s important that all of those who care for individuals with diabetes, including those in primary care specialties, surgical specialties, and mental health have a strong medical knowledge in both how to prevent and how to manage hypoglycemia.

Anthony L. McCall, MD, PhD, FACP, professor of medicine and endocrinology (Emeritus)  University of Virginia School of Medicine, Charlottesville, Va.

EN: What are the key take-home messages for patients in this guideline?

DCL: We want persons with diabetes to know how many new and exciting therapeutic advances there have been with regard to hypoglycemia in the last decade! New insulins and new glucagon formulations, and continued advancements in CGM and insulin pump technology, are doing much to help identify, prevent, and treat hypoglycemia. These all help improve glucose time-in-range, and importantly, improve quality of life.