Hypoglycaemia is one of the most important aspects of diabetes care. Hypoglycaemia is considered the main obstacle in reaching the glycaemic target for diabetic patients. It is most commonly present in type 1 diabetes, followed by type 2 diabetes treated with insulin or sulfonylureas. Having frequent episodes of hypoglycaemia can also decrease the body’s normal responses to hypoglycaemia and induce “hypoglycaemia unawareness”. Common complications associated with hypoglycaemia include comas, mild intellectual impairment, and permanent neurological sequelae. There is a significant association between an increased risk of mortality and severe hypoglycaemia in individuals with type 2 diabetes and cardiovascular disease. Multiple studies have reported that hypoglycaemia is linked to increased mortality and morbidity. Hypoglycaemia causes a significant clinical and psychological burden on diabetic patients. A recent study reported that fear of hypoglycaemia is related to poorer glucose control and psychological well-being, negatively affecting patients’ quality of life. Studies showed that among antidiabetic medications, sulfonylureas were most commonly associated with hypoglycaemia.

The management of hypoglycaemia includes the prompt detection of hypoglycaemia and timely treatment using agents that quickly increase blood glucose level. Continuous glucose monitoring (CGM) sensor technology aids in achieving good glycaemic control. CGM, along with an insulin infusion pump or a sensor-augmented pump, significantly reduces hypoglycaemia. Reactive hypoglycaemia and hypoglycaemia in nondiabetic patients mostly occur during the postprandial period, with complete recovery occurring after taking carbohydrates. Although it is uncommon, hypoglycaemia can occur in nondiabetic individuals like in cases of critical illness, adrenal insufficiency, non-islet cell tumours secreting IGF-II, after bariatric surgery, endogenous hyperinsulinism, functional β-cell disorders, and prediabetic conditions. In such cases, accurate diagnosis is needed for the provision of nutrients, or medical or surgical treatment. In a recent trial, intensive blood glucose lowering led to hypoglycaemia, which in turn was associated with a risk of macrovascular and microvascular events and eventually death. It also increases the risk of digestive, respiratory, and skin disorders as well as acting as marker of comorbidity burden.

This Special Issue aims to solicit articles covering various aspects of hypoglycaemia including epidemiology, aetiology, and diagnostic and treatment modalities. Articles dealing with the consequences of hypoglycaemia (such as fear or unawareness) or the role of antidiabetic medications, insulin pumps, and CGM in hypoglycaemia will also be included. Special attention will be given to articles with newer technologies used for the identification of hypoglycaemia and for reducing the risk of adverse outcomes. Review articles regarding the incidence and prevalence of hypoglycaemia as well as various topics related to hypoglycaemia will also be considered.

Potential topics include but are not limited to the following:

• Epidemiology of hypoglycaemia
• Risk factors for hypoglycaemia
• Pathophysiology of hypoglycaemia
• Impact of hypoglycaemia
• Hypoglycaemia in special populations, such as the elderly or pregnant
• Fear of hypoglycaemia
• Hypoglycaemia unawareness
• Antidiabetic medications and hypoglycaemia
• New technology, especially insulin pumps, and hypoglycaemia
• Hypoglycaemia and exercise
• Role of CGM to lower hypoglycaemia risk
• Hypoglycaemic education and quality of life
• Severe hypoglycaemia
• Hypoglycaemia prevention
• Hypoglycaemia treatment