Epidemiology and risk factors of hypoglycemia in subjects with type 1 diabetes in Brazil: a cross-sectional, multicenter study

Abstract

Objective:The aim of this study was to investigate the factors associated with hypoglycemia and severe hypoglycemia (SH) in individuals with type 1 diabetes mellitus (T1D) in Brazil. Materials and methods: This multicenter, cross-sectional study was conducted between August 2011 and August 2014 across 10 Brazilian cities. The data were obtained from 1,760 individuals with T1D. Sociodemographic and clinical characteristics related to hypoglycemic events in the previous 4 weeks were evaluated. Results: Of 1,760 individuals evaluated, 1,319 (74.9%) reported at least one episode of hypoglycemia in the previous 4 weeks. The main factors associated with hypoglycemia were lower hemoglobin A1c (HbA1c) level, better adherence to self-monitoring of blood glucose (SMBG), and higher education level. Episodes of SH were reported by 251 (19%) individuals who, compared with subjects with nonsevere hypoglycemia, received lower doses of prandial insulin and higher doses of basal insulin, in addition to reporting less frequent use of long-acting basal insulin analogs. The percentage of SH episodes was evenly distributed across all ranges of HbA1c levels, and there were no correlations between the mean number of nonsevere or severe hypoglycemic events and HbA1c values. Higher alcohol consumption and more frequent hospitalizations were independently associated with SH. Conclusion: Although individuals presenting with hypoglycemia had lower HbA1c values than those not presenting hypoglycemia, there were no correlations between the number of nonsevere hypoglycemia or SH and HbA1c values. Also, the frequency of SH was evenly distributed across all ranges of HbA1c values. Better adherence to SMBG and higher education level were associated with hypoglycemia, while alcohol consumption, higher doses of basal insulin, and more frequent hospitalizations in the previous year were associated with SH.

Heterogeneity of glycaemic phenotypes in type 1 diabetes

“…We did not find any association between Dim2 and social vulnerability, which aligns with previous research findings [37,38]. Hypoglycaemia is likely driven by other mechanisms not directly associated with social vulnerability [39].…”

Hypoglycemia in type 1 diabetes: a burden to worry about during treatment

“…Basal insulin is a key component of insulin therapy in type 1 diabetes and the present Brazilian study ( 19 ) was able to show the value of this part of insulin therapy that, at higher doses, was associated to more prevalence of severe hypoglycemic episodes.…”

“…Finally, weekly alcohol consumption in the Brazilian study ( 19 ) demonstrated an odds ratio of 5.64 to severe hypoglycemia, after final adjusted logistic regression analysis with SH, as the dependent variable. In the existing literature, the rates of alcohol consumption by type 1 diabetes younger adults range from 19.3% to 26% ( 23 ).…”

“…Therefore, the publication of the results of a cross-sectional, multicenter study showing the epidemiology and the risk factors of hypoglycemia in subjects with type 1 diabetes in Brazil, in this issue of Archives of Endocrinology and Metabolism, by de Souza and cols. ( 19 ), will collaborate for the analyses of the reasons for the differences in hypoglycemia rates among the global regions, offering us data to reduce this complex clinical problem during insulin therapy in type 1 diabetes patients.…”