Nationwide reduction in the frequency of severe hypoglycemia by half

Fredheim, Siri; Johansen, Anders; Thorsen, Sixtus; Kremke, Britta; Nielsen, L.B.; Olsen, Birthe Susanne; Lyngsøe, L.; Sildorf, Stine Møller; Pipper, Christian Bressen; Mortensen, Henrik B.; Johannesen, Jesper; Svensson, Jannet

doi:10.1007/s00592-014-0697-5

Cited by 44 publications

(66 citation statements)

References 21 publications

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“…Hypoglycemia is a common disorder among diabetic patients, which may be reducing due to changes in diabetes care and success of educational programs [32]. It does not always result in hospitalization; therefore, it is possible that Analyses adjusted for calendar period, sex and age at T1D diagnosis Acta Diabetol the number of events identified in our study may represent an underestimate.…”

Section: Discussionmentioning

confidence: 70%

A nationwide population-based study on the risk of coma, ketoacidosis and hypoglycemia in patients with celiac disease and type 1 diabetes

et al. 2015

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Section: Discussionmentioning

confidence: 70%

A nationwide population-based study on the risk of coma, ketoacidosis and hypoglycemia in patients with celiac disease and type 1 diabetes

et al. 2015

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“…During that period a large increase in patients on pump therapy was observed. 9 However, the SH rate in Sweden was stable and low (between 2 and 5 per 100 patient-years) and in Norway the SH rate was stable at a higher level (between 7 and 10 per 100 patient-years), despite a lower percentage of patients using insulin pump in Sweden compared with Denmark and Norway. When analyzed in toto, there appeared to be an association between insulin pump use and lower rates of SH; however, this association was not consistently seen across individual countries nor did it explain the variance in rates of sever hypoglycemia between countries.…”

Section: Pathophysiology/complicationsmentioning

confidence: 94%

“…[8][9][10] In the same period, an increased number of BG measurements and insulin bolus injections have been recommended. 3 These changes may all contribute to reduce the frequency of SH.…”

Section: Pathophysiology/complicationsmentioning

confidence: 99%

“…3 These changes may all contribute to reduce the frequency of SH. Thus, a report from the German and Austrian 'Diabetes Patienten Verlaufsdokumentation' (DPV) database has shown a decrease in the relative risk of SH, particularly in the groups with the lowest HbA 1c , 11 a study from the Danish Registry of Childhood and Adolescent Diabetes (DanDiabKids) showed a significant decrease in SH in the period 2008-2012 with unchanged HbA 1c , 9 and a multicenter and multinational study from the Hvidoere Study Group showed significant differences in the frequency of SH between diabetes centers in different countries. 12 Finally, a recent multicenter study, including the DPV database and large centers from Australia and the USA, reported the SH incidence independent of HbA 1c , 13 but investigations in other large longitudinal cohorts were called for.…”

Section: Pathophysiology/complicationsmentioning

confidence: 99%

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Incidence of severe hypoglycemia in children with type 1 diabetes in the Nordic countries in the period 2008–2012: association with hemoglobin A_{_1c}and treatment modality

Birkebæk

Drivvoll

Aakeson

et al. 2017

BMJ Open Diab Res Care

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ObjectiveTreatment of type 1 diabetes has been intensified aiming at normalizing blood glucose, which may increase the risk of severe hypoglycemia (SH). We aimed to compare the incidence of SH events in the four Nordic countries Denmark, Iceland, Norway and Sweden, and to assess the influence of hemoglobin A1c (HbA1c) and treatment modalities on the frequency of SH; particularly, to explore if a HbA1c target ≤6.7% (50 mmol/mol) is feasible.Research design and methodsData on children below 15 years with a diabetes duration more than 1 year, registered in the national childhood diabetes databases in the four Nordic countries from 2008 to 2012, were compiled. Data completeness was more than 95%.ResultsTotally 8806 (48% females) patients with 29 715 person years were included, mean age and diabetes duration were 11 years and 5.1 years, respectively. The overall rate of SH was 6.0 per 100 patient-years, and did not change during the study period. The Swedish population constantly had the lowest SH incidence while it decreased significantly in the Danish population. HbA1c decreased significantly over time (p<0.01), while the number of pump users increased (p<0.01). Stratifying for HbA1c levels showed the lowest risk of SH in patients with HbA1c ≤6.7% (≤50 mmol/mol), but in the statistical models adjusting for possible confounders the difference between the HbA1c groups disappeared. Pump users had the lowest SH risk, also after adjusting for possible confounders.ConclusionsRisk of SH differs between the Nordic countries with the lowest risk in Sweden. Pump therapy was associated with decreased risk of SH. The low HbA1c group had the same or a lower risk of SH compared with the highest HbA1c groups. A target HbA1c ≤6.7% (≤50 mmol/mol) seems achievable without increasing the risk of SH.

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“…However, a number of more recent studies have not confirmed the strong association between optimization of glycemic control and an increase in risk of SH in children, adolescents, and adults. [18][19][20][21][22][23][24] Nevertheless, CGM might be a technical solution assisting the achievement of both treatment goals. It is of interest to note that in a recent publication no indication was found that CGM usage reduces SH, fear of hypoglycemia, hypoglycemia awareness, or even biochemical hypoglycemia.…”

Section: Risk Of Hypoglycemic Events In Patients With Type 1 Diabetesmentioning

confidence: 99%

HypoDE

Heinemann

Deiss

Hermanns

et al. 2015

J Diabetes Sci Technol

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The evidence for continuous glucose monitoring (CGM) to improve HbA1c without increasing the risk of hypoglycemic events has been established. Yet, after more than a decade of availability, the evidence for usage of CGM to reduce the risk of hypoglycemic events (especially of severe hypoglycemic events [SH]) from a number of studies remains under debate.1-6 However, in many of these studies first generations CGM systems were used; the analytical performance, reliability, and usability of these systems were considerably worse than more recent CGM system generations. Although real-time CGM per se (that mean CGM only, without communicating with an insulin pump; subsequently the term CGM will be used in this sense) has been shown to reduce the amount of time a user spends at low glucose, it has not demonstrated to be effective in reducing such low glucose events in general and nocturnal events during sleep. [5][6][7][8] In most studies performed to date, CGM systems were used by patients with type 1 diabetes that utilize continuous subcutaneous insulin infusion therapy (CSII) by means of insulin pumps, there is less data on patients using multiple daily injection (MDI) therapy by means of syringes or pens AbstractSystems for continuous glucose monitoring (CGM) have been available for a number of years, and numerous clinical studies have been performed with them. Interestingly, in many of these studies patients with an increased risk of hypoglycemic events were excluded. In addition, in most studies subjects were using a pump for insulin delivery. Therefore our knowledge about the benefit of CGM in patients employing multiple daily injections (MDI) of insulin is limited, especially when it comes to a reduction in the risk of low glucose events in high-risk individuals. We are planning to run a 26-week randomized controlled study in Germany (HypoDE, Hypoglycemia in Deutschland) that is focused on evaluating if such a reduction can be observed in patients on MDI with an increased risk of low glucose events. In all, 160 patients will participate in the study, randomized into the intervention group and control group. Ideally one would study if the frequency of severe hypoglycemic events is different between both groups. However, this would require such a large sample size and study duration, so for pragmatic reasons we will use low glucose levels <55 mg/dl (measured by CGM) for at least 20 minutes as a risk marker for severe hypoglycemic events. The results from the HypoDE study shall help determine the advantage of using CGM in subjects with type 1 diabetes with an increased risk of low glucose events treated with MDI.

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Nationwide reduction in the frequency of severe hypoglycemia by half

Abstract: A nationwide halving in rates of severe hypoglycemia was observed during the study period independent of the prevailing average HbA1c level. Changes in diabetes care and successful educational programs may have influenced the lower incidence rate of severe hypoglycemia.

Cited by 44 publications

References 21 publications

A nationwide population-based study on the risk of coma, ketoacidosis and hypoglycemia in patients with celiac disease and type 1 diabetes

A nationwide population-based study on the risk of coma, ketoacidosis and hypoglycemia in patients with celiac disease and type 1 diabetes

Incidence of severe hypoglycemia in children with type 1 diabetes in the Nordic countries in the period 2008–2012: association with hemoglobin A_{_1c}and treatment modality

HypoDE

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Nationwide reduction in the frequency of severe hypoglycemia by half

Abstract: A nationwide halving in rates of severe hypoglycemia was observed during the study period independent of the prevailing average HbA1c level. Changes in diabetes care and successful educational programs may have influenced the lower incidence rate of severe hypoglycemia.

Cited by 44 publications

References 21 publications

A nationwide population-based study on the risk of coma, ketoacidosis and hypoglycemia in patients with celiac disease and type 1 diabetes

A nationwide population-based study on the risk of coma, ketoacidosis and hypoglycemia in patients with celiac disease and type 1 diabetes

Incidence of severe hypoglycemia in children with type 1 diabetes in the Nordic countries in the period 2008–2012: association with hemoglobin A1cand treatment modality

HypoDE

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Product

Resources

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Incidence of severe hypoglycemia in children with type 1 diabetes in the Nordic countries in the period 2008–2012: association with hemoglobin A_{_1c}and treatment modality