Clinical Characterisation of Severe Hypoglycaemia

Holstein, Andreas; Plaschke, A.; Egberts, E.‐H.

doi:10.1055/s-2003-42728

Cited by 112 publications

(71 citation statements)

References 22 publications

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“…In addition, our crude incidence of HSH was consistent with those in other studies which used comparable methods of ascertainment [23,28]. However, because the sample size was not large and the follow-up period was relatively short, the study may have had limited power to investigate the association between incident hypoglycaemia and cognitive decline.…”

Section: Discussionsupporting

confidence: 83%

Severe hypoglycaemia and cognitive impairment in older patients with diabetes: the Fremantle Diabetes Study

et al. 2009

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Aims/hypothesis The aim was to investigate the relationship between severe hypoglycaemia and cognitive impairment in older patients with diabetes. Methods A sample of 302 diabetic patients aged ≥70 years was assessed for dementia or cognitive impairment without dementia in 2001-2002 and a subsample of non-demented patients (n=205) was followed to assess cognitive decline. A history of severe hypoglycaemia was determined from self-reports, physician assessments and records of health service use for hypoglycaemia (HSH). Prospective HSH was determined up to 2006. Data analysis, including multiple logistic and Cox regression models, was used to determine whether: (1) there were cross-sectional associations between hypoglycaemia and cognitive status, (2) historical hypoglycaemia predicted cognitive decline, and (3) baseline cognitive status predicted subsequent HSH.Results There were significant cross-sectional associations between both cognitive impairment and dementia and hypoglycaemia. Independent risk factors for future HSH included dementia (hazard ratio 3.00, 95% CI 1.06-8.48) and inability to self-manage medications (hazard ratio 4.17, 95% CI 1.43-12.13). However, there were no significant associations between historical hypoglycaemia, incident HSH and cognitive decline. Conclusions/interpretation Dementia is an important risk factor for hypoglycaemia requiring health service utilisation. We found no evidence that hypoglycaemia contributes to cognitive impairment in older patients with diabetes.

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Section: Discussionsupporting

confidence: 83%

Severe hypoglycaemia and cognitive impairment in older patients with diabetes: the Fremantle Diabetes Study

et al. 2009

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“…A number of studies describing the frequency of SH have been published [7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22] . However, most of these studies have been performed with a selected cohort 7,8,[11][12][13][14][15][16][17][18][19][20][21][22] .…”

Section: Introductionmentioning

confidence: 99%

Severe hypoglycaemia requiring the assistance of emergency medical services - frequency, causes and symptoms

Krnacova¹,

Kubêna²,

Macek³

et al. 2012

BIOMED PAP

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Aims.To evaluate the incidence of severe hypoglycaemia (SH) requiring the assistance of Emergency Medical Services (EMS) in the general population of the Hradec Králové region, in a 1 year period; to describe the distribution of these events throughout the day, and to analyse the symptoms and causes. Methods. The outcome data were obtained from special forms which were filled in by EMS medical staff. Incidence of SH was calculated and the distribution of events throughout the day was analysed using contingency tables. The relationship between blood glucose levels and the presence or absence of causes and symptoms of hypoglycaemia was evaluated using a general linear model and the regression tree technique. Results. In all, a total of 338 events of SH were recorded in 262 patients. 150 episodes appeared in type 2 diabetic patients, 83 episodes in type 1 diabetic patients. 258 events were documented in insulin-treated patients. The incidence of SH was 2.4 and 0.4 episodes/100 patients/year for type 1 and type 2 diabetic patients, respectively. A significantly greater number of hypoglycaemic episodes was documented between 2 pm and 6 pm (P<0.001). Insulin therapy and alcohol consumption were the most dangerous causes of SH. Conclusions. Hypoglycaemia requiring the assistance of EMS represents an essential problem, especially in type 1 diabetic patients. The percentage of SH is comparable to other frequent diagnoses requiring the assistance of EMS in the region. This study reflects the behaviour of diabetic patients and highlights information which is important in the prevention of SH.

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“…Older diabetic patients using four or more concomitant medications have been found to be at increased risk for developing serious hypoglycaemia. 8,25 Polypharmacy can also precipitate geriatric syndromes such as fall, cognitive impairment, urinary incontinence, and malnutrition. 26,27 Fall and fracture…”

Section: Polypharmacymentioning

confidence: 99%

“…Diabetic patients with low-to-moderate co-morbidity have been found to have a lower incidence of cardiovascular events than those with high co-morbidity, even with comparable HbA1c levels. 39 Furthermore, comorbidity, especially renal impairment, hepatic disease and cognitive dysfunction increase the risk of severe hypoglycaemia, 25 which is associated with twice the risk of cardiovascular disease (myocardial infarction, congestive heart failure, stroke, and cardiovascular death) in diabetic patients. 40 Diabetic patients with concomitant coronary artery disease who experience hypoglycaemia are particularly prone to ischaemic heart attack.…”

Section: Co-morbidities and Other Cardiovascular Risk Factorsmentioning

confidence: 99%

Diabetes in older people: position statement of The Hong Kong Geriatrics Society and the Hong Kong Society of Endocrinology, Metabolism and Reproduction

Lee

Tam³

et al. 2017

Hong Kong Med J

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A B S T R A C TFollowing a survey on the clinical practice of geriatricians in the management of older people with diabetes and a study of hypoglycaemia in diabetic patients, a round-table discussion with geriatricians and endocrinologists was held in January 2015. Consensus was reached for six domains specifically related to older diabetic people: (1) the considerations when setting an individualised diabetic management; (2) inclusion of geriatric syndrome screening in assessment; (3) glycaemic and blood pressure targets; (4) pharmacotherapy; (5) restrictive diabetic diet; and (6) management goals for nursing home residents.

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Clinical Characterisation of Severe Hypoglycaemia

Cited by 112 publications

References 22 publications

Severe hypoglycaemia and cognitive impairment in older patients with diabetes: the Fremantle Diabetes Study

Severe hypoglycaemia and cognitive impairment in older patients with diabetes: the Fremantle Diabetes Study

Severe hypoglycaemia requiring the assistance of emergency medical services - frequency, causes and symptoms

Diabetes in older people: position statement of The Hong Kong Geriatrics Society and the Hong Kong Society of Endocrinology, Metabolism and Reproduction

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