Nocturnal Hypoglycemia (NH)
and CGM Technology
1. The Silent Burden
Critical Frequency
It is estimated that
55% of all episodes of
severe hypoglycemia
occur at night. 1
Diagnostic invisibility
51% of severe
nocturnal events
are not detected
by the patient
while sleeping.1
Psychological impact
Fear of nocturnal hypoglycemia
impairs quality of life and leads
patients to maintain intentionally
elevated glucose levels to avoid
nocturnal events.2
2. Unique characteristics of nocturnal episodes
Prolonged duration
Nocturnal episodes (<70 mg/dL)
last significantly longer than
daytime episodes: 60 minutes
versus 35 minutes.3
Diminished autonomic response
During sleep, the autonomic and
symptomatic response to
hypoglycemia is reduced, making it
difficult for the patient to wake up
or recognize the event.4
Predominance in the late phase
Between 60% and 70% of nocturnal
hypoglycemia episodes occur in the
second half of the night (3:00–7:00 a.m.),
when the counterregulatory hormone
response is less pronounced.1
3. The Impact Upon Waking
Evidence Against the Somogyi Effect
CGM data refute the classical
theory; following a night of
hypoglycemia, morning
glucose levels tend to be
lower (median difference of
-25.3 mg/dL), not higher.3
Cognitive consequences
Nocturnal hypoglycemia is
directly associated with
slower cognitive processing
speed the following day.1
Socioeconomic impact
Each episode of nocturnal
hypoglycemia results in an
average loss of 14.7 hours
of work time due to fatigue
and reduced productivity.1
Persistent instability
Nocturnal events increase
glycemic variability (GV)
and elevate the risk of new
hypoglycemia episodes the
following day.3
4. How the prediction tool can help
Beyond the current alarms
Traditional threshold alarms
can cause alarm fatigue and
sleep disruptions, leading
some patients to disable
them.5
Proactive prevention
AI algorithms in CGM that
estimate the risk of
nocturnal hypoglycemia for
the next 7 hours before the
patient goes to sleep.6
Performance del Algoritmo
The predictive algorithm in the
Accu-Chek SmartGuide CGM
offers 86.5% accuracy, correctly
predicting whether nocturnal
hypoglycemia will occur on more
than 27 out of 30 nights.6
References:
- Kulzer B, et al. Nocturnal hypoglycemia in the era of continuous glucose monitoring. J Diabetes Sci Technol. 2024.
- Ehrmann D, et al. Fear of Hypoglycemia and Diabetes Distress: Expected Reduction by Glucose Prediction. J Diabetes Sci Technol. 2024.
- Eichenlaub M, et al. Characteristics of Nocturnal Hypoglycemic Events and Their Impact on Glycaemia. J Diabetes Sci Technol. 2024.
- Schnell O, Ziegler R. The Promise of Hypoglycemia Risk Prediction. J Diabetes Sci Technol. 2024.
- Barnard-Kelly KD, et al. Identifying the deficiencies of currently available MCG to improve uptake and benefit. Diabet Med. 2024.
- Herrero P, et al. Enhancing the Capabilities of Continuous Glucose Monitoring With a Predictive App. J Diabetes Sci Technol. 2024.