Impact of symptomatic hypoglycemia on medication adherence, patient satisfaction with treatment, and glycemic control in patients with type 2 diabetes

Abstract

BackgroundThe purpose of this study was to evaluate the impact of symptomatic hypoglycemia on medication adherence, satisfaction with treatment, and glycemic control in patients with type 2 diabetes based on the treatment goals stated in the Swedish national guidelines.MethodsThis cross-sectional, multicenter study was carried out between January and August 2009 in 430 consecutive primary health care patients on stable doses of metformin and sulfonylureas for at least 6 months. The patients completed questionnaires covering their experiences of low blood glucose and adherence, as well as barriers to and satisfaction with drug treatment (using the Treatment Satisfaction Questionnaire for Medication). Physicians collected the data from medical records.ResultsPatients who experienced moderate or worse symptoms of hypoglycemia reported poorer adherence to medication (46% versus 67%; P<0.01) and were more likely to perceive barriers such as “bothered by medication side effects” (36% versus 14%; P<0.001) compared with patients with no or mild symptoms. Patients with moderate or worse symptoms of hypoglycemia were less satisfied with their treatment than those with no or mild symptoms as determined by the Treatment Satisfaction Questionnaire for Medication-Global satisfaction (67.0 versus 71.2; P<0.05). Overall, achievement of target glycated hemoglobin (HbA1c) based on the treatment goals stated in the Swedish national guidelines was 40%. Despite poorer adherence, patients who experienced moderate or worse symptoms of hypoglycemia had lower mean HbA1c values than patients with no or mild symptoms (7.0% versus 7.3% [Diabetes Control and Complications Trial standard]; P<0.05).ConclusionSymptomatic hypoglycemia in patients with type 2 diabetes on metformin and sulfonylureas was associated with nonadherence and decreased treatment satisfaction despite lower mean HbA1c values. A broader understanding of patient preferences and self-reported outcomes could improve the management of patients with type 2 diabetes.

Psychosocial Care for People With Diabetes: A Position Statement of the American Diabetes Association

“…If FoH is identified and a person does not have symptoms of hypoglycemia, a structured program, Blood Glucose Awareness Training, delivered in routine clinical practice can improve A1C, reduce the rate of severe hypoglycemia, and restore hypoglycemia awareness (70,71). Such improvements in disease state have been shown to reduce diabetes distress and improve psychological well-being (69,72,73). …”

Combination of Empagliflozin and Linagliptin as Second-Line Therapy in Subjects With Type 2 Diabetes Inadequately Controlled on Metformin

“…Hypoglycemia is associated with increased morbidity and mortality (23), reduced quality of life (24), and poor glycemic control (25) in patients with type 2 diabetes. Thus the risk of hypoglycemia is an important consideration for the choice of add-on therapy for patients with type 2 diabetes who do not achieve adequate glycemic control with metformin (1).…”

Drug-related risk of severe hypoglycaemia in observational studies: a systematic review and meta-analysis

“…We reviewed 318 full texts, from which 58 manuscripts describing 24 individual trials (18 new studies) [126–183] were eligible for the systematic review. The details of trial identification are given in Additional file 3.…”