Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Observational Study
. 2016 Sep;18(9):907-15.
doi: 10.1111/dom.12689. Epub 2016 Jun 20.

Rates and predictors of hypoglycaemia in 27 585 people from 24 countries with insulin-treated type 1 and type 2 diabetes: the global HAT study

K Khunti  1 , S Alsifri  2 , R Aronson  3 , M Cigrovski Berković  4 , C Enters-Weijnen  5 , T Forsén  6 , G Galstyan  7 , P Geelhoed-Duijvestijn  8 , M Goldfracht  9   10 , H Gydesen  11 , R Kapur  11 , N Lalic  12 , B Ludvik  13 , E Moberg  14 , U Pedersen-Bjergaard  15 , A Ramachandran  16 ; HAT Investigator Group
Affiliations
Observational Study

Rates and predictors of hypoglycaemia in 27 585 people from 24 countries with insulin-treated type 1 and type 2 diabetes: the global HAT study

K Khunti et al. Diabetes Obes Metab. 2016 Sep.

Abstract

Aims: To determine the global extent of hypoglycaemia experienced by patients with diabetes using insulin, as there is a lack of data on the prevalence of hypoglycaemia in developed and developing countries.

Methods: This non-interventional, multicentre, 6-month retrospective and 4-week prospective study using self-assessment questionnaire and patient diaries included 27 585 patients, aged ≥18 years, with type 1 diabetes (T1D; n = 8022) or type 2 diabetes (T2D; n = 19 563) treated with insulin for >12 months, at 2004 sites in 24 countries worldwide. The primary endpoint was the proportion of patients experiencing at least one hypoglycaemic event during the observational period.

Results: During the prospective period, 83.0% of patients with T1D and 46.5% of patients with T2D reported hypoglycaemia. Rates of any, nocturnal and severe hypoglycaemia were 73.3 [95% confidence interval (CI) 72.6-74.0], 11.3 (95% CI 11.0-11.6) and 4.9 (95% CI 4.7-5.1) events/patient-year for T1D and 19.3 (95% CI 19.1-19.6), 3.7 (95% CI 3.6-3.8) and 2.5 events/patient-year (95% CI 2.4-2.5) for T2D, respectively. The highest rates of any hypoglycaemia were observed in Latin America for T1D and Russia for T2D. Glycated haemoglobin level was not a significant predictor of hypoglycaemia.

Conclusions: We report hypoglycaemia rates in a global population, including those in countries without previous data. Overall hypoglycaemia rates were high, with large variations between geographical regions. Further investigation into these differences may help to optimize therapy and reduce the risk of hypoglycaemia.

Keywords: HAT study; diabetes; global; hypoglycaemia; insulin; observational.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Overall and nocturnal hypoglycaemia rates during the prospective period by geographic region. (A) Patients with type 1 diabetes. (B) Patients with type 2 diabetes. PPY, per patient‐year; SE, Southeast.
Figure 2
Figure 2
Relationship between estimated rates of any hypoglycaemia and (A) duration of insulin treatment and (B) duration of diabetes. Fully adjusted negative binomial modelling of the associations between patient characteristics and incidence rate ratios for (C) any, (D) nocturnal or (E) severe hypoglycaemia in the global trial population. Part A shows duration of insulin therapy for type 1 diabetes (T1D), lower quartile 7.0 years, median 15.0 years, upper quartile 24.0 years; for type 2 diabetes (T2D), lower quartile 2.0 years, median 5.0 years, upper quartile 9.0 years. Part B shows duration of diabetes for T1D, lower quartile 8.0 years, median 15.0 years, upper quartile 24.0 years; for T2D, lower quartile 8.0 years, median 12.0 years, upper quartile 18.0 years. HbA1c, glycated haemoglobin; PPY, per patient‐year.
Figure 3
Figure 3
Percentage of patients reporting hypoglycaemia during the prospective period, stratified by glycated haemoglobin (HbA1c) level for patients with type 1 and type 2 diabetes.
See this image and copyright information in PMC

References

    1. Leiter LA, Boras D, Woo VC. Dosing irregularities and self‐treated hypoglycemia in type 2 diabetes: results from the Canadian cohort of an international survey of patients and healthcare professionals. Can J Diabetes 2014; 38: 38–44. - PubMed
    1. Inzucchi SE, Bergenstal RM, Buse JB et al. Management of hyperglycemia in type 2 diabetes: a patient‐centered approach: position statement of the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD). Diabetes Care 2012; 35: 1364–1379. - PMC - PubMed
    1. Chiang JL, Kirkman MS, Laffel LM, Peters AL, Type 1 Diabetes Sourcebook Authors . Type 1 diabetes through the life span: a position statement of the American Diabetes Association. Diabetes Care 2014; 37: 2034–2054. - PMC - PubMed
    1. Horvath K, Jeitler K, Berghold A et al. Long‐acting insulin analogs vs. NPH insulin (human isophane insulin) for type 2 diabetes mellitus. Cochrane Database Syst Rev 2007: Apr 18;(2):CD005613. - PubMed
    1. Richter B, Bandeira‐Echtler E, Bergerhoff K, Lerch CL. Dipeptidyl peptidase‐4 (DPP‐4) inhibitors for type 2 diabetes mellitus. Cochrane Database Syst Rev 2008: 16;(2):CD006739. - PMC - PubMed

Publication types

MeSH terms