Severe hypoglycaemia in drug-treated diabetic patients needs attention: A population-based study

Abstract

Objective. To study one-year incidence and risk factors of severe hypoglycaemias (SH) in adult drug-treated diabetic patients living in two Finnish communities. Design. The episodes of SH and their risk factors were identifi ed from local ambulance registers, from the databases of local health care units, and from patient questionnaires. Setting. The target population consisted of all drug-treated diabetic patients from the two middle-sized communities in southern Finland, altogether 1776 patients. The study was retrospective. Subjects. A total of 1469 patients (82.7% of the target population) gave informed consent for the use of their medical records and 1325 patients (74.6% of the target population) returned the detailed 36-item questionnaire. Results. Of type 1 and type 2 insulin-treated diabetic patients, 14.6% and 1.0%, respectively, needed ambulance or emergency room care (incidence of 30.5 and 3.0 per 100 patient years). However, 31.0% of type 1 and 12.3% of type 2 diabetic patients reported at least one episode of SH (incidence of 72.0 and 27.0 per 100 patient years). Of all insulin-treated patients, 53 (7.8%) reported three or more episodes of SH. Signifi cant independent risk factors for SH were depression, daily exercise, and nephropathy but not glycaemic control. Conclusion. The incidence of SH was high in both types of insulin-treated diabetic patients. However, the recurrent episodes of SH were clustered in a small minority of insulin-treated patients with diabetes. The risk of SH should be considered when assessing the treatment target for an individual diabetic patient.

Low Socioeconomic Status is Associated with Increased Risk for Hypoglycemia in Diabetes Patients: The Diabetes Study of Northern California (DISTANCE)

“…Because hypoglycemia was assessed similarly in all three studies, we suspect that the higher rates of hypoglycemia in the DISTANCE Study cohort reflect the true risk in an ethnically diverse, real-world diabetes cohort, relative to more selective trial cohorts. Population-based studies in Finnish 40 and German 41 diabetes patients reported similarly high population rates of hypoglycemia. Glycemic targets based on data from highly selected populations with low rates of hypoglycemia may overestimate net clinical benefit for real-world patients.…”

Association of Depression With Increased Risk of Severe Hypoglycemic Episodes in Patients With Diabetes

“…2,[9][10][11] Although behavioral, physiologic, and therapeutic factors have been examined as causes of hypoglycemia, the authors are aware of only one study that examined the association of depression with severe hypoglycemic episodes in a population of adults with diabetes. 12 This study found that depression increased risk of hypoglycemic episodes. The study had several limitations, however, including use of an unvalidated depression measure and that data on hypoglycemic episodes were from the year before depression ascertainment.…”

“…12 A previous study found that depression was associated with self-reported hypoglycemic episodes (which included both minor and more severe episodes) in 2,718 patients with type 2 diabetes. 25 The increased risk of severe hypoglycemic episodes in patients with comorbid depression may be due to poor self-care or psychobiologic changes associated with depression.…”

Experiences, Views, and Support Needs of Family Members of People With Hypoglycemia Unawareness: Interview Study

“…They could also use these appointments to help ensure that caregivers are offered education and information about applying hypoglycemia management. Health professionals could also consider extending similar kinds of support to family members of people with type 2 diabetes using insulin or sulfonylureas, as these individuals are also vulnerable to HU and associated problems (25)(26)(27).…”