Self-reported hypoglycemia and impact on quality of life and depression among adults with type 2 diabetes mellitus
Introduction
Hypoglycemia is a leading limiting factor in the glycemic management of adults with type 2 diabetes mellitus (T2DM) [1]. Glycemic control prevents or delays microvascular complications (retinopathy, nephropathy, and neuropathy) in T2DM [2]. However, diabetes management is complex, and hypoglycemia is a barrier to the achievement of glycemic control. Hypoglycemia is itself an emergency that is uncomfortable, disruptive to an individual's routine, and occasionally dangerous if it is severe and results in neuroglycopenia, and so must be avoided. As a result, metabolic control may be compromised, which increases the risk of microvascular complications of diabetes [3].
Hypoglycemia often causes physical and psychosocial morbidity and sometimes causes death [3]. A recent study in the United States found a significant association between hypoglycemia and lower health-related quality of life (HRQOL) [4], [5]. Frequency of severe hypoglycemia (i.e. that requiring assistance of another individual) during aggressive insulin therapy in T2DM ranged from 3 to 73 episodes per 100 patient-years [3]. Over 6 years of follow-up of patients with T2DM in the United Kingdom Prospective Diabetes Study (UKPDS) clinical trial, 2.4% of those using metformin, 3.3% of those using a sulfonylurea, and 11.2% of those using insulin reported major hypoglycemic events that required medical attention or admission to the hospital [2]. However, data from patients with T2DM treated in general clinical practice are limited. This investigation was designed to provide current, real-world rates of self-reported hypoglycemia and to determine the impact of hypoglycemia on HRQOL and association with depression among adults with T2DM.
Section snippets
Methods
The present investigation is a cross-sectional analysis of data from the Study to Help Improve Early evaluation and management of risk factors Leading to Diabetes (SHIELD) assessing the association between hypoglycemia and HRQOL and depression. SHIELD is a 5-year, survey-based study conducted to better understand patterns of health status, health behavior, and knowledge and attitudes of people living with diabetes and those with varying levels of cardiometabolic risk.
Prevalence of hypoglycemia
A total of 3000 respondents with T2DM were included in the 2008 SHIELD survey, and 23% (n = 690) reported at least 1 episode of hypoglycemia in the past 12 months. Additionally, 20.5% of T2DM respondents reported having hypoglycemia during the 4 weeks prior to completing the survey. Over the 4-week period, T2DM respondents reported an average of 6.4 (SD = 11.7) episodes of hypoglycemia.
A significantly (p < 0.001) larger proportion of T2DM respondents reporting hypoglycemic episodes consisted of
Discussion
Self-reported hypoglycemia was prevalent and frequent among adults with T2DM, with approximately one-fourth of respondents reporting hypoglycemia within a 12-month period. Physical and mental quality of life was significantly lower among T2DM respondents reporting hypoglycemia than among those who did not report hypoglycemia. Those with more hypoglycemic episodes in a 4-week period had significantly lower physical health quality of life than respondents with 1 episode. Respondents reporting
Conflict of interest
The authors have a competing interest to declare. This research was supported by funds from AstraZeneca LP.
Acknowledgments
Members of the SHIELD Study Group are: Harold Bays, MD, Louisville Metabolic and Atherosclerosis Research Center, Louisville, KY; Debbra D. Bazata, RD, CDE, St. Luke's Primary Care South, Overland Park, KS; James R. Gavin III, MD, PhD, Emory University School of Medicine, Atlanta, GA; Andrew J. Green, MD, Midwestern Endocrinology, Overland Park, KS; Sandra J. Lewis, MD, Northwest Cardiovascular Institute, Portland, OR; Michael L. Reed, PhD, Vedanta Research, Chapel Hill, NC; and Helena W.
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