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. 2014 Dec;5(2):447-58.
doi: 10.1007/s13300-014-0075-x. Epub 2014 Jul 15.

Increased Risk of Severe Hypoglycemic Events with Increasing Frequency of Non-severe Hypoglycemic Events in Patients with Type 1 and Type 2 Diabetes

Seamus Sreenan  1 , Marc Andersen, Brian Larsen Thorsted, Michael L Wolden, Marc Evans
Affiliations

Increased Risk of Severe Hypoglycemic Events with Increasing Frequency of Non-severe Hypoglycemic Events in Patients with Type 1 and Type 2 Diabetes

Seamus Sreenan et al. Diabetes Ther. 2014 Dec.

Abstract

Introduction: Severe hypoglycemic events (SHEs) are associated with significant morbidity, mortality and costs. However, the more common non-severe hypoglycemic events (NSHEs) are less well explored. We investigated the association between reported frequency of NSHEs and SHEs among patients with type 1 diabetes mellitus (T1DM) and type 2 diabetes mellitus (T2DM) in the PREDICTIVE study.

Methods: PREDICTIVE was a global, prospective, observational study. Patients with T1DM (n = 7,420) or T2DM (n = 12,981), starting treatment with insulin detemir, reported the number of NSHEs and SHEs experienced during the 4 weeks prior to baseline and follow-up visits (mean 14.4 weeks). Logistic regression was used to determine the odds ratio (OR) of experiencing ≥1 SHE, in patients having 1-4 or ≥5 NSHEs, versus those having 0 NSHEs, while controlling for baseline covariates.

Results: Hypoglycemia rates were lower at follow-up than baseline. At baseline 59.2% (T1DM) and 18.8% (T2DM) reported any hypoglycemia and at follow-up 39.5% (T1DM) and 8.6% (T2DM). There was a significant (P < 0.0001) increase in the odds of ≥1 SHEs with increasing frequency of NSHEs in T1DM and T2DM, for both crude and adjusted estimates. At baseline, in T1DM, ORs for ≥1 SHE were 1.92 and 2.13 for 1-4 and ≥5 NSHEs, respectively; the corresponding ORs in T2DM were 10.83 and 15.36, respectively. At follow-up, the ORs for ≥1 SHE were 2.01 and 3.20 (T1DM) and 18.99 and 24.29 (T2DM) for 1-4 and ≥5 NSHEs, respectively.

Conclusion: A statistically significant association between NSHE and SHE frequency was found in T1DM and T2DM. These data provide a clear rationale for the reduction of hypoglycemic events, regardless of severity, while striving for optimal glycemic control.

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Figures

Fig. 1
Fig. 1
Hypoglycemic events recorded during 4 weeks before baseline and 4 weeks before follow-up, for type 1 and type 2 diabetes mellitus, in the PREDICTIVE study. NSHE non-severe hypoglycemic event, SHE severe hypoglycemic event
Fig. 2
Fig. 2
Adjusted odds ratio estimates for experiencing ≥1 SHEs for T1DM (top) and T2DM (bottom), at baseline in the PREDICTIVE study. P values are for the covariate named on the left. BMI body mass index, CI confidence interval, HbA 1c glycosylated hemoglobin, NSHE non-severe hypoglycemic event, SHE severe hypoglycemic event, T1DM type 1 diabetes mellitus, T2DM type 2 diabetes mellitus
Fig. 3
Fig. 3
Adjusted odds ratio estimates for experiencing ≥1 SHEs for T1DM (top) and T2DM (bottom), at follow-up in the PREDICTIVE study. P values are for the covariate named on the left. BMI body mass index, CI confidence interval, HbA 1c glycosylated hemoglobin, NSHE non-severe hypoglycemic event, SHE severe hypoglycemic event, T1DM type 1 diabetes mellitus, T2DM type 2 diabetes mellitus
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References

    1. Brod M, Christensen T, Thomsen TL, Bushnell DM. The impact of non-severe hypoglycemic events on work productivity and diabetes management. Value Health. 2011;14(5):665–671. doi: 10.1016/j.jval.2011.02.001. - DOI - PubMed
    1. Barendse S, Singh H, Frier BM, Speight J. The impact of hypoglycaemia on quality of life and related patient-reported outcomes in type 2 diabetes: a narrative review. Diabet Med. 2012;29(3):293–302. doi: 10.1111/j.1464-5491.2011.03416.x. - DOI - PubMed
    1. Brod M, Christensen T, Bushnell DM. Impact of nocturnal hypoglycemic events on diabetes management, sleep quality, and next-day function: results from a four-country survey. J Med Econ. 2012;15(1):77–86. doi: 10.3111/13696998.2011.624144. - DOI - PubMed
    1. Leiter LA, Yale J-F, Chiasson J-L, Harris S, Kleinstiver P, Sauriol L. Assessment of the impact of fear of hypoglycemic episodes on glycemic and hypoglycemia management. Can J Diab. 2005;29:186–192.
    1. Frier BM. How hypoglycaemia can affect the life of a person with diabetes. Diabetes Metab Res Rev. 2008;24(2):87–92. doi: 10.1002/dmrr.796. - DOI - PubMed

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