Impact of self-treated hypoglycaemia in type 2 diabetes: a multinational survey in patients and physicians

Abstract

Objectives: The objectives were to estimate the prevalence of self-treated hypoglycaemia in patients using basal insulin analogues; identify demographic, treatment related and behavioural risk factors; and describe patient and physician responses to these events.

Research design and methods: The GAPP2 (Global Attitude of Patients and Physicians 2) study was an online multinational cross-sectional study of patients with type 2 diabetes currently treated with basal insulin, and healthcare professionals involved in the care of such patients. The primary variable of interest was self-treated hypoglycaemia within the last 30 days.

Results: A total of 3042 patients treated with basal insulin analogues and 1222 prescribers completed the full survey. Overall, 36% of patients had experienced self-treated hypoglycaemia during the previous 30 days. In response to self-treated hypoglycaemia, patients reported missing (7%), reducing (11%) or mistiming (4%) basal insulin doses, increasing the level of glucose monitoring (40%) or utilising healthcare resources (7%). Patients reporting irregular basal insulin dosing by missing, mistiming or reducing a dose were also significantly more likely to report an episode of self-treated hypoglycaemia in the same time period: 41% versus 34% (p = 0.004), 43% versus 33% (p < 0.001), and 56% versus 32% (p < 0.001) respectively. Nocturnal events worried significantly more patients than diurnal events (42% versus 23%, p < 0.001). Patient worry about hypoglycaemia, insulin regimen and reduced basal dosing were identified as the key differentiating variables associated with increased risk of self-treated hypoglycaemic events. Most prescribers (76%) believed that insulin analogues minimised the risk of nocturnal hypoglycaemia when compared to NPH insulin; 46% also reported being contacted at least once a month by insulin analogue patients after self-treated hypoglycaemic events.

Conclusions: Self-treated hypoglycaemia is common in approximately one third of patients using insulin analogue regimens. Additionally, self-treated hypoglycaemia was found to be associated with clinically significant effects on patient well-being and functioning, patient and physician management and healthcare utilisation despite the potential limitations of an online self-complete survey such as the need to be topic focused, the potential for under-reporting and social bias.