Article Text
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.
- hypoglycemia
- hypoglycemia unawareness
- type 2 diabetes
- epidemiology
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Footnotes
Presented at Part of the results of this study have been presented at the 78th Scientific Sessions of the American Diabetes Association, Orlando, FL, 22-26 June 2018.
Contributors BEDG and CJT designed the study. FdV analyzed the data. LAvM wrote the first draft of the manuscript. LAvM, FdV, EJA, FR, MTS, MMvdK, BHRW, SS, JHD, EJGS, BÖ, HWdV, BS, NS, CDAS, PJE, CJT, BEDG critically revised and contributed to the final version of the manuscript. LAvM, FdV, CJT and BEDG. are the guarantors of this work and accept full responsibility for the work and/or the conduct of the study, had access to the data, and controlled the decision to publish. The corresponding author attests that all listed authors meet authorship criteria and that no others meeting the criteria have been omitted.
Funding The initial organization of the Dutch Diabetes Pearl was co-financed by the Dutch Government and the eight Dutch University Medical Centers. The continuation is financed by the Dutch Federation of University Medical Centers. The funding body had no role in designing the study or in collecting, analyzing, or interpreting data, writing of the report or in the decision to submit the article for publication. The research has been conducted fully independent of the funders, and all authors, external and internal, had full access to all of the data (including statistical reports and tables) in the study and can take responsibility for the integrity of the data and the accuracy of the data analysis.
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.
Patient consent for publication Not required.
Provenance and peer review Not commissioned; externally peer reviewed.
Data availability statement All data relevant to the study are included in the article or uploaded as supplementary information.