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Observational Study
. 2020 Feb;8(1):e000935.
doi: 10.1136/bmjdrc-2019-000935.

High prevalence of impaired awareness of hypoglycemia and severe hypoglycemia among people with insulin-treated type 2 diabetes: The Dutch Diabetes Pearl Cohort

Lian A van Meijel  1 , Femmie de Vegt  2 , Evertine J Abbink  3 , Femke Rutters  4 , Miranda T Schram  5 , Melanie M van der Klauw  6 , Bruce H R Wolffenbuttel  6 , Sarah Siegelaar  7 , J Hans DeVries  7 , Eric J G Sijbrands  8 , Behiye Özcan  8 , Harold W de Valk  9 , Bianca Silvius  9 , Nicolaas Schaper  5 , Coen D A Stehouwer  5 , Petra J M Elders  10 , Cornelis J Tack  3 , Bastiaan E de Galan  3   5
Affiliations
Observational Study

High prevalence of impaired awareness of hypoglycemia and severe hypoglycemia among people with insulin-treated type 2 diabetes: The Dutch Diabetes Pearl Cohort

Lian A van Meijel et al. BMJ Open Diabetes Res Care. 2020 Feb.

Abstract

Objective: People with type 2 diabetes on insulin are at risk for hypoglycemia. Recurrent hypoglycemia can cause impaired awareness of hypoglycemia (IAH), and increase the risk for severe hypoglycemia. The aim of this study was to assess the prevalence and determinants of self-reported IAH and severe hypoglycemia in a Dutch nationwide cohort of people with insulin-treated type 2 diabetes.

Research design and methods: Observational study of The Dutch Diabetes Pearl, a cohort of people with type 2 diabetes treated in primary, secondary and tertiary diabetes care centers. The presence of IAH and the occurrence of severe hypoglycemia in the past year, defined as an event requiring external help to recover, were assessed using the validated Dutch version of the Clarke questionnaire. In addition, clinical variables were collected including age, diabetes duration, hemoglobin A1c, ethnicity and education.

Results: 2350 people with type 2 diabetes on insulin were included: 59.1% men, mean age 61.1±10.4 years, mean diabetes duration 14.8±9.2 years and 79.5% on basal-bolus therapy. A total of 229 patients (9.7%) were classified as having IAH and 742 patients (31.6%) reported severe hypoglycemia. Increased odds for IAH were found with complex insulin regimens and lower odds with having a partner and body mass index ≥30 kg/m2. Severe hypoglycemia was associated with complex insulin regimens, non-Caucasian ethnicity and use of psychoactive drugs, and inversely with metformin use.

Conclusions: In this nationwide cohort, almost one out of ten people with type 2 diabetes on insulin had IAH and >30% had a history of severe hypoglycemia in the past year.

Keywords: epidemiology; hypoglycemia; hypoglycemia unawareness; type 2 diabetes.

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Conflict of interest statement

Competing interests: FR has received grants from the Dutch government, during the conduct of the study. JHD has received personal fees from Novo Nordisk and Sanofi, outside the submitted work. CJT has received grants from AstraZeneca, personal fees and other from NovoNordisk and from Merck, outside the submitted work. BEDG has received grants from the Dutch Federation of University Medical Centers, during the conduct of the study and personal fees from NovoNordisk, outside the submitted work.

Figures

Figure 1
Figure 1
Flow diagram showing patient selection.
Figure 2
Figure 2
Proportion (%) of patients with IAH (top) or severe hypoglycemia (SH) (bottom) according to glycemic category, 7%=53 mmol/mol, 8%=64 mmol/mol, *P value for trend <0.05. IAH, impaired awareness of hypoglycemia.
See this image and copyright information in PMC

References

    1. Geller AI, Shehab N, Lovegrove MC, et al. . National estimates of insulin-related hypoglycemia and errors leading to emergency department visits and hospitalizations. JAMA Intern Med 2014;174:678–86.10.1001/jamainternmed.2014.136 - DOI - PMC - PubMed
    1. UK Hypoglycaemia Study Group Risk of hypoglycaemia in types 1 and 2 diabetes: effects of treatment modalities and their duration. Diabetologia 2007;50:1140–7.10.1007/s00125-007-0599-y - DOI - PubMed
    1. Zammitt NN, Frier BM. Hypoglycemia in type 2 diabetes: pathophysiology, frequency, and effects of different treatment modalities. Diabetes Care 2005;28:2948–61.10.2337/diacare.28.12.2948 - DOI - PubMed
    1. International Hypoglycaemia Study Group Minimizing hypoglycemia in diabetes. Diabetes Care 2015;38:1583–91.10.2337/dc15-0279 - DOI - PubMed
    1. Akram K, Pedersen-Bjergaard U, Carstensen B, et al. . Frequency and risk factors of severe hypoglycaemia in insulin-treated type 2 diabetes: a cross-sectional survey. Diabet Med 2006;23:750–6.10.1111/j.1464-5491.2006.01880.x - DOI - PubMed

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