Hypoglycaemia in adults with insulin‐treated diabetes in the UK: self‐reported frequency and effects

Abstract

AimFew real‐life studies of non‐severe (self‐treated) hypoglycaemic events are available. This survey quantified the self‐reported frequency of non‐severe hypoglycaemia and its effects in adults with insulin‐treated diabetes in the UK.MethodsAdults aged > 15 years with Type 1 diabetes or insulin‐treated Type 2 diabetes completed ≤ 4 weekly questionnaires (7–day recall). Respondents with Type 2 diabetes were grouped by insulin regimen: basal‐only, basal–bolus and ‘other’.ResultsOverall, 1038 respondents (466 with Type 1 diabetes, 572 with Type 2 diabetes) completed 3528 questionnaires. Mean numbers of non‐severe events per week were 2.4 (Type 1 diabetes; median = 2) and 0.8 (Type 2 diabetes; median = 0); 23% and 26% of non‐severe events occurred at night, respectively. Fatigue and reduced alertness were the commonest issues following events (78% and 51% of respondents, respectively). The effects of nocturnal events persisted longer than those of daytime events: Type 1 diabetes = 10.6 vs. 4.9 h (P = 0.0002); Type 2 diabetes = 15.3 vs. 5.1 h (P < 0.0001). In the week following an event, respondents’ blood glucose measurements increased by 4.3 (Type 1 diabetes; 12% increment) and 4.2 (Type 2 diabetes; 21% increment) tests/week. In employed respondents, 20% of events caused work‐time loss, more so following nocturnal (vs. daytime) hypoglycaemia: Type 1 diabetes = 2.7 vs. 1.1 h (P = 0.0184); Type 2 diabetes = 2.5 vs. 1.6 h (P = 0.1340). Most respondents rarely/never informed healthcare professionals about events (Type 1 diabetes = 82%, Type 2 diabetes = 69%).ConclusionsNon‐severe hypoglycaemia is common in adults with insulin‐treated diabetes in the UK, with consequent health‐related/economic effects. Communication about non‐severe hypoglycaemia is limited and the burden of hypoglycaemia may be underestimated.

Ambulatory glucose profile (AGP): utility in UK clinical practice

“…27,28 Even nonsevere hypoglycaemia can impair sleep, well-being and ability to work, and can impact strongly and negatively on family life and on the overall management of diabetes. 29,30 Fear of hypoglycaemia may lead to less stringent glycaemic targets being set and/or affect the willingness and ability of people with diabetes to try to achieve these targets. 29 Fear of hypoglycaemia promotes adverse selfmanagement behaviours such as insulin dose reduction or omission or 'defensive snacking', with an adverse effect on overall glycaemic control.…”

“…29,30 Fear of hypoglycaemia may lead to less stringent glycaemic targets being set and/or affect the willingness and ability of people with diabetes to try to achieve these targets. 29 Fear of hypoglycaemia promotes adverse selfmanagement behaviours such as insulin dose reduction or omission or 'defensive snacking', with an adverse effect on overall glycaemic control. 29 The challenge of hypoglycaemia in diabetes management is compounded by the relatively common phenomenon of hypoglycaemia unawareness, where repeated bouts of severe hypoglycaemia reduce the ability of the patient to identify and deal with a subsequent hypoglycaemic episode.…”

Risk factors for hypoglycaemia in in-patients with diabetes treated with continuous insulin intravenous infusion

“…Hypoglycaemia is a common health problem in diabetic patients, especially those treated with insulin [9]. Nowadays, hypoglycaemia is considered as a particularly unfavourable event in the course of diabetes treatment [4,6].…”

Driving and diabetes: are the changes in the European Union licensing regulations fit for purpose?

“…[26][27][28] Affected individuals felt tired, slow, depressed and restless on the day after nocturnal hypoglycaemia. [29][30][31] Negative effects have been reported on work attendance, performance and productivity. [28][29][30][31] There is evidence that hypoglycaemia during sleep is relevant to a person's ability to function normally after awakening, whether this is in the morning after nocturnal hypoglycaemia or at some other time of day.…”

“…[29][30][31] Negative effects have been reported on work attendance, performance and productivity. [28][29][30][31] There is evidence that hypoglycaemia during sleep is relevant to a person's ability to function normally after awakening, whether this is in the morning after nocturnal hypoglycaemia or at some other time of day. Following an episode of severe nocturnal hypoglycaemia, drivers should be advised to avoid driving the following day, at least in the hours after awakening.…”