Ambady Ramachandran, Subramanium Venkatraman, Anand Moses and Gunupati Vijayakumar
Glycaemic control is often disturbed by iatrogenic hypoglycaemia as a result of intensive treatment and can be a major barrier to optimal glycaemic management. This risk of hypoglycaemia acts like a deterrent to the patient from achieving euglycaemia. The fear of hypoglycaemia leads to “defensive snacking” which further disrupts achievement of euglycaemia and leads to weight gain. Obesity by itself carries a major risk for adverse cardiovascular outcomes and coupled with hypoglycaemia significantly increases the cardiovascular risk in patients with diabetes. “Hyp-obesity” is a new term that effectively conveys the present challenges in achieving euglycaemia due to hypoglycaemia and obesity and would help facilitate therapeutic strategies to optimise diabetes management. Newer drugs targeting the incretin pathway such as glucagon-like peptide-1 (GLP-1) mimetic and dipeptidyl peptidase-4 (DPP-4) inhibitors would be beneficial in minimising the risk of hypoglycaemia and obesity.