Real-world crude incidence of hypoglycemia in adults with diabetes: Results of the InHypo-DM Study, Canada

Abstract

ObjectiveVery few real-world studies have been conducted to assess the incidence of diabetes-related hypoglycemia. Moreover, there is a paucity of studies that have investigated hypoglycemia among people taking secretagogues as a monotherapy or in combination with insulin. Accordingly, our research team developed and validated the InHypo-DM Person with Diabetes Mellitus Questionnaire (InHypo-DMPQ) with the aim of capturing the real-world incidence of self-reported, symptomatic hypoglycemia. The questionnaire was administered online to a national sample of Canadians (≥18 years old) with type 1 diabetes mellitus (T1DM) or type 2 diabetes mellitus (T2DM) treated with insulin and/or insulin secretagogues.Research design and methodsSelf-report data obtained from the InHypo-DMPQ were descriptively analyzed to ascertain the crude incidence proportions and annualized incidence densities (rates) of 30-day retrospective non-severe and 1-year retrospective severe hypoglycemia, including daytime and nocturnal events.ResultsA total of 552 people (T2DM: 83%; T1DM: 17%) completed the questionnaire. Over half (65.2%) of the total respondents reported experiencing at least one event (non-severe or severe) at an annualized crude incidence density of 35.1 events per person-year. The incidence proportion and rate of non-severe events were higher among people with T1DM versus T2DM (77% and 55.7 events per person-year vs 54% and 28.0 events per person-year). Severe hypoglycemia was reported by 41.8% of all respondents, at an average rate of 2.5 events per person-year.ConclusionsThe results of the InHypo-DMPQ, the largest real-world investigation of hypoglycemia epidemiology in Canada, suggest that the incidence of hypoglycemia among adults with diabetes taking insulin and/or insulin secretagogues is higher than previously thought.

Relationship between glycated hemoglobin level and duration of hypoglycemia in type 2 diabetes patients treated with sulfonylureas: A multicenter cross‐sectional study

“…Previous studies with CGM showed that hypoglycemia occurred more frequently during the night than during the daytime in insulin-treated patients with type 1 or type 2 diabetes 18,19 . In contrast, daytime hypoglycemic events were more frequent than nocturnal hypoglycemic events in a study based on self-reporting of such events 20 . In the present study, we found that the duration of nocturnal hypoglycemia was longer than that of daytime hypoglycemia, and became longer as the HbA 1c level decreased.…”

Lower rates of hypoglycaemia in older individuals with type 2 diabetes using insulin degludec versus insulin glargine U100: Results from SWITCH 2

“…There was a numerically greater rate of severe hypoglycaemia in older individuals compared with younger individuals (RR, 1.38) in the current trial, although the trend was not statistically significant. Severe hypoglycaemia is generally much more common in real‐world populations than in randomized clinical trials . In addition, continuous glucose monitoring has demonstrated that many episodes are unrecognized and under‐reported .…”

“…Severe hypoglycaemia is generally much more common in real-world populations than in randomized clinical trials. 4,5,32 In addition, continuous glucose monitoring has demonstrated that many episodes are unrecognized and under-reported. 33 Furthermore, it has been estimated that only 5% of self-reported severe hypoglycaemia events among individuals with diabetes who are underging pharmacological treatment are captured by traditional healthcare utilization-based surveillance systems, suggesting a substantial underestimate of the true burden.…”

“…Hypoglycaemia, primarily associated with diabetes therapies, particularly insulin, is common in T2D, and increases with age and longer duration of diabetes . Non‐severe episodes are associated with increased utilization of healthcare services and loss of work time, as well as impairment of quality of life; prevention of these episodes is therefore important.…”

“…1,2 In an ageing population with increasing longevity, the global burden of diabetes in individuals 65 years of age or older is projected to increase from 122.8 million in 2017 to 253.4 million in 2045. 3 Hypoglycaemia, primarily associated with diabetes therapies, particularly insulin, is common in T2D, 4,5 and increases with age and longer duration of diabetes. 6 Non-severe episodes are associated with increased utilization of healthcare services and loss of work time, [7][8][9] as well as impairment of quality of life; prevention of these episodes is therefore important.…”