Hypoglycemia in Type 2 Diabetes - More Common Than You Think

Abstract

Background: Hypoglycemia is often the limiting factor for intensive glucose control in diabetes management, however its actual prevalence in type 2 diabetes (T2DM) is not well documented. Methodology: A total of 108 patients with T2DM wore a continuous glucose monitoring system (CGMS) for 5 days. Rates and patterns of hypoglycemia and glycemic variability (GV) were calculated. Patient and medication factors were correlated with rates, timing, and severity of hypoglycemia. Results: Of the patients, 49.1% had at least 1 hypoglycemic episode (mean 1.74 episodes/patient/ 5 days of CGMS) and 75% of those patients experienced at least 1 asymptomatic hypoglycemic episode. There was no significant difference in the frequency of daytime versus nocturnal hypoglycemia. Hypoglycemia was more frequent in individuals on insulin (alone or in combination) ( P = .02) and those on oral hypoglycemic agents ( P < .001) compared to noninsulin secretagogues. CGMS analysis resulted in treatment modifications in 64% of the patients. T2DM patients on insulin exhibited higher glycemic variability (GV) scores (2.3 ± 0.6) as compared to those on oral medications (1.8 ± 0.7, P = .017). Conclusions: CGMS can provide rich data that show glucose excursions in diabetes patients throughout the day. Consequently, unwarranted onset of hypo- and hyperglycemic events can be detected, intervened, and prevented by using CGMS. Hypoglycemia was frequently unrecognized by the patients in this study (75%), which increases their potential risk of significant adverse events. Incorporation of CGMS into the routine management of T2DM would increase the detection and self-awareness of hypoglycemia resulting in safer and potentially better overall control.

Hypoglycemia Risk Factors among Hospitalized Type 2 Diabetes Mellitus Patients

“…This finding is similar with previous study showed that lower HbA1c level was associated with higher hypoglycemia prevalence. 10 This study found no association between the use of benzodiazepines, ACEI, RASB, CCB, beta-blockers, diuretics, and lipid lowering agents with hypoglycemic events during hospitalization. Although these drugs have been reported to increase the risk of hypoglycemic events, 9 it is likely that most hypoglycemic episodes are relatively mild or undocumented.…”

“…Research conducted in Atlanta found that the most hypoglycemic associated events were skipping meals or delaying meals. 10 A study conducted in Mexico in patients treated in the emergency room found that a history of fasting or skipping meals before admission increased the probability of occurrence hypoglycemic nearly 20 fold. 11 Previous studies also showed that restriction of carbohydrate intake was one of the drug-induced hypoglycemic risk factors.…”

Hypoglycemia after initiating insulin therapy based on the results of structured self-control and monitoring of blood glucose

“…При оценке гипогликемий в стационаре на фоне инсулинотера-пии 6-кратное измерение гликемии в день позволило выя-вить гипогликемии у 22% пациентов при их частоте в 72% по результатам мониторирования в течение 2 суток [6]. В другом исследовании [10], включавшем 108 пациентов с сахарным диабетом 2-го типа с различной сахароснижа-ющей терапией, хотя бы один эпизод гипогликемии был выявлен у 49% пациентов и у 37% отмечались ночные гипо-гликемии. Также из всех эпизодов гипогликемии 75% были бессимптомными, что демонстрирует низкую надежность определения гипогликемий только лишь на основе симпто-мов или измерения глюкозы крови при их появлении.…”

Continuous Glucose Monitoring with Multiple Daily Insulin Treatment: Outcome Studies

“…59 Gehlaut et al found that 49% of patients with type 2 diabetes in their study had at least one episode of hypoglycemia during a 5-day analysis with CGM and many of those hypoglycemic episodes were asymptomatic. 58 They also found that 21% of those patients found to have hypoglycemia had values <50 mg/dL and episodes were most common in those on insulin. Cariou et al 57 evaluated a mixed population of patients with type 1 and 2 diabetes in an observational study over 30 days and found that 45% of patients reported at least one episode of hypoglycemia.…”

“…The rate of hypoglycemia in type 2 diabetes is higher than usually appreciated. [57][58][59] For example Lipska et al reported that 10.8% of patients in the large database experienced severe hypoglycemia. 59 Gehlaut et al found that 49% of patients with type 2 diabetes in their study had at least one episode of hypoglycemia during a 5-day analysis with CGM and many of those hypoglycemic episodes were asymptomatic.…”