Incidence and risk factors for severe and symptomatic hypoglycemia in type 1 diabetes. Results of the HYPOS-1 study

Giorda, Carlo; Ozzello, Alessandro; Gentile, Sandro; Aglialoro, A.; Chiambretti, Anna; Baccetti, Fabio; Gentile, Francesco; Lucisano, Giuseppe; Nicolucci, Antonio; Rossi, Maria Chiara

doi:10.1007/s00592-015-0713-4

Cited by 88 publications

(77 citation statements)

References 25 publications

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“…CAD, infection, and poor renal function have been reported to be associated with risks of recurrent hypoglycemia [31]. The HYPOS-1 study reported the rate of hypoglycemia was higher in patients with previous severe hypoglycemia, neuropathy, long duration, and on polypharmacy [18]. Therefore, patients with more comorbidies are at risk for recurrent hypoglycemia and should be closely monitored.…”

Section: Discussionmentioning

confidence: 99%

“…Finally, polypharmacy and anti-diabetic agents are identified as risk factors for hypoglycemia. In HYPOS-1 study, polypharmacy was associated with a 24% excess of risk for hypoglycemia [18]. Hypoglycemia episodes were higher among those with insulin and insulin secretagogues [15, 27].…”

Section: Discussionmentioning

confidence: 99%

“…Some evidences showed hypoglycemia in the previous 6 months was associated with recurrent hypoglycemia in T2DM patients [16, 17]. HYPOS-1 study demonstrated 16.5% T1DM patients experienced severe hypoglycemia in the past 12 months and 78.6% patients had at least one hypoglycemia in the past 4 weeks [18]. To our best of knowledge, no longer interval was studied in the literature.…”

Section: Methodsmentioning

confidence: 99%

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Epidemiology and outcomes of hypoglycemia in patients with advanced diabetic kidney disease on dialysis: A national cohort study

et al. 2017

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BackgroundPatients with advanced diabetic kidney disease (DKD) behave differently to diabetic patients without kidney disease. We aimed to investigate the associations of hypoglycemia and outcomes after initiation of dialysis in patients with advanced DKD on dialysis.MethodsUsing National Health Insurance Research Database, 20,845 advanced DKD patients beginning long-term dialysis between 2002 and 2006 were enrolled. We investigated the incidence of severe hypoglycemia episodes before initiation of dialysis. Patients were followed from date of first dialysis to death, end of dialysis, or 2008. Main outcomes measured were all-cause mortality, myocardial infarction (MI), and subsequent severe hypoglycemic episodes after dialysis.Results19.18% patients had at least one hypoglycemia episode during 1-year period before initiation of dialysis. Advanced DKD patients with higher adapted Diabetes Complications Severity Index (aDCSI) scores were associated with more frequent hypoglycemia (P for trend < 0.001). Mortality and subsequent severe hypoglycemia after dialysis both increased with number of hypoglycemic episodes. Compared to those who had no hypoglycemic episodes, those who had one had a 15% higher risk of death and a 2.3-fold higher risk of subsequent severe hypoglycemia. Those with two or more episodes had a 19% higher risk of death and a 3.9-fold higher risk of subsequent severe hypoglycemia. However, previous severe hypoglycemia was not correlated with risk of MI after dialysis.ConclusionsThe rate of severe hypoglycemia was high in advanced DKD patients. Patients with higher aDCSI scores tended to have more hypoglycemic episodes. Hypoglycemic episodes were associated with subsequent hypoglycemia and mortality after initiation of dialysis. We studied the associations and further study is needed to establish cause. In addition, more attention is needed for hypoglycemia prevention in advanced DKD patients, especially for those at risk patients.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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Epidemiology and outcomes of hypoglycemia in patients with advanced diabetic kidney disease on dialysis: A national cohort study

et al. 2017

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“…Association of HbA 1c levels with hypoglycemia has varied in different studies (30)(31)(32). Viewing the analysis by updated data in our study, an inverted U-shaped curve was observed for any hypoglycemia by HbA 1c categories in patients with use of insulin or of SUR without insulin.…”

Section: Discussionmentioning

confidence: 99%

Predisposing Factors for Any and Major Hypoglycemia With Saxagliptin Versus Placebo and Overall: Analysis From the SAVOR-TIMI 53 Trial

Cahn¹,

Mosenzon

Leibowitz³

et al. 2016

Diabetes Care

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OBJECTIVETo analyze the impact of adding saxagliptin versus placebo on the risk for hypoglycemia and to identify predictors of any and major hypoglycemia in patients with type 2 diabetes included in the Saxagliptin Assessment of Vascular Outcomes Recorded in Patients with Diabetes Mellitus-Thrombolysis in Myocardial Infarction 53 (SAVOR-TIMI 53) study. RESEARCH DESIGN AND METHODSPatients with type 2 diabetes (n = 16,492) were randomized to saxagliptin or placebo and followed for a median of 2.1 years. Associations between any hypoglycemia (symptomatic or glucose measurement <54 mg/dL) or major hypoglycemia (requiring extended assistance) and patient characteristics overall and by treatment allocation were studied. RESULTSAt least one hypoglycemic event was reported in 16.6% of patients, and 1.9% reported at least one major event. Patients allocated to saxagliptin versus placebo experienced higher rates of any (hazard ratio [HR] 1.16 [95% CI 1.08, 1.25]; P < 0.001) or major (HR 1.26 [1.01, 1.58]; P = 0.038) hypoglycemia. Hypoglycemia rates (any or major) were increased with saxagliptin in patients taking sulfonylureas (SURs) but not in those taking insulin. Rates were increased with saxagliptin in those with baseline HbA 1c £7.0% and not in those with baseline HbA 1c >7.0%. Multivariate analysis of the overall population revealed that independent predictors of any hypoglycemia were as follows: allocation to saxagliptin, long duration of diabetes, increased updated HbA 1c , macroalbuminuria, moderate renal failure, SUR use, and insulin use. Predictors of major hypoglycemia were allocation to saxagliptin, advanced age, black race, reduced BMI, long duration of diabetes, declining renal function, microalbuminuria, and use of short-acting insulin. Among SURs, glibenclamide was associated with increased risk of major but not any hypoglycemia. CONCLUSIONSThe identification of patients at risk for hypoglycemia can guide physicians to better tailor antidiabetic therapy.

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“…3 Structured diabetes education delivered in routine practice for persons with type 1 diabetes have been found to at least halving rates of severe hypoglycaemia (SH) 4 and lead to reduced emergency treatment costs. 5 Past experience of SH is associated with greater fear of hypoglycaemia (FoH) in individuals with type 1 diabetes, suggesting that the experience of hypoglycaemia plays an important role in triggering FoH.…”

mentioning

confidence: 99%

A longitudinal study of fear of hypoglycaemia in adults with type 1 diabetes

Anderbro

Amsberg

Moberg

et al. 2018

Endocrino Diabet & Metabol

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Summary Aims To investigate fear of hypoglycaemia (FoH) longitudinally in a cross‐sectional study of adult patients with type 1 diabetes. Specifically, we investigated two subgroups of patients who over 4 years either showed a substantial increase or decrease in level of FoH to identify factors associated with changes in FoH. Methods The Swedish version of the Hypoglycaemia Fear Survey (HFS) along with a questionnaire to assess hypoglycaemia history was sent by mail to 764 patients in 2010. The responders in 2010 (n = 469) received another set of the same two questionnaires in 2014. HbA1c, insulin regimen, weight and creatinine from 2010 and 2014 were obtained from medical records. Those with an absolute difference in HFS scores ≥ 75th percentile were included in the subgroup analyses. Statistical analyses included one‐sample t tests, chi‐square and McNemar's test. Results The absolute difference in the HFS total score (n = 347) between 2010 and 2014 was m = ±7.6, SD ± 6. In the increased FoH group, more patients reported a high level of moderate hypoglycaemic episodes as well as impaired awareness of hypoglycaemia in 2014 compared with the decreased FoH group. There were more subjects in the increased FoH group with insulin pumps in 2014 and in 2010. In the decreased FoH group, more patients had a high frequency of daily self‐monitoring of blood glucose (SMBG) in 2010 and in 2014. Conclusions Fear of hypoglycaemia is stable across time for most patients. Changes in fear level are associated with changes in hypoglycaemia frequency. Thus, asking patients about changes in hypoglycaemia experiences is of great importance.

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Incidence and risk factors for severe and symptomatic hypoglycemia in type 1 diabetes. Results of the HYPOS-1 study

Cited by 88 publications

References 25 publications

Epidemiology and outcomes of hypoglycemia in patients with advanced diabetic kidney disease on dialysis: A national cohort study

Epidemiology and outcomes of hypoglycemia in patients with advanced diabetic kidney disease on dialysis: A national cohort study

Predisposing Factors for Any and Major Hypoglycemia With Saxagliptin Versus Placebo and Overall: Analysis From the SAVOR-TIMI 53 Trial

A longitudinal study of fear of hypoglycaemia in adults with type 1 diabetes

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