Hypoglycemia in Type 2 Diabetes Pathophysiology, frequency, and effects of different treatment modalities

T he importance of strict glycemiccontrol to limit the risk of diabeticvascular complications is indisput-able, but many barriers obstruct its attain-ment. Hypoglycemia is recognized to be a major limitation in achieving good con-trol in type 1 diabetes (1) but has been considered to be a minor problem of the treatment modalities used for type 2 dia-betes (2). This may be a misperception based on inadequate information. The burden of covert hypoglycemia associated with oral antidiabetic agents may be un-derestimated, and with the increasing use of insulin to treat type 2 diabetes, the ac-tual prevalence of hypoglycemia is likely to escalate. The frequency and pathophysiology of hypoglycemia in type 2 diabetes and the relationship to different therapies was reviewed by conducting a literature search using the bibliographic database PubMed to identify publications in En-glish from 1984 until 2005 related to hy-poglycemia associated with treatment of type 2 diabetes, and the bibliographies of relevant articles were scrutinized for ad-ditional citations. Search terms included “type 2 diabetes, ” “NIDDM, ” “non-insulin-dependent diabetes, ” “hypoglyce