Frequency of Severe Hypoglycemia in Patients With Type I Diabetes With Impaired Awareness of Hypoglycemia

Gold, Ann; MacLeod, Kenneth M.; Frier, Brian M.

doi:10.2337/diacare.17.7.697

Cited by 699 publications

(665 citation statements)

References 21 publications

(24 reference statements)

Supporting

Mentioning

619

Contrasting

Unclassified

Order By: Relevance

“…However, the long-duration group experienced the highest frequency of severe episodes (prevalence 46%, mean rate 3.2 episodes per subject-year), confirming the increased risk of severe hypoglycaemia with increasing duration of type 1 diabetes [1,16,19]. The mean rate was substantially higher than that reported during the DCCT [19] and comparable with those observed in patients with hypoglycaemia unawareness [14]. This emphasises that rates of hypoglycaemia are often higher in unselected populations than in those in clinical trials [5], and also that even type 1 diabetic patients of long duration who do not report unawareness remain vulnerable to severe episodes due to failure of hypoglycaemic counter-regulation [20].…”

Section: Discussionsupporting

confidence: 57%

“…Stimulated C-peptide concentrations, reflecting endogenous insulin secretory capacity, were highest among individuals taking sulfonylureas and lowest (at the limit of detection) in patients with type 1 diabetes of long duration, as anticipated. A hypoglycaemia awareness score was obtained by asking subjects to rate their awareness of the symptoms of hypoglycaemia, where 1 stands for fully aware of the onset of symptoms, and 7 stands for totally unaware [14]. The mean scores showed that awareness was greatest among patients on sulfonylureas and patients with type 2 diabetes who had recently started on insulin.…”

Section: Not Eligible N=35mentioning

confidence: 99%

See 1 more Smart Citation

Risk of hypoglycaemia in types 1 and 2 diabetes: effects of treatment modalities and their duration

2007

Diabetologia

749

259

View full text Add to dashboard Cite

Aims/hypothesis We explored the epidemiology of hypoglycaemia in individuals with insulin-treated diabetes by testing the hypothesis that diabetes type and duration of insulin treatment influence the risk of hypoglycaemia. Materials and methods This was an observational study over 9-12 months in six UK secondary care diabetes centres. Altogether 383 patients were involved. Patients were divided into the following three treatment groups for type 2 diabetes: (1) sulfonylureas, (2) insulin for <2 years and (3) insulin for >5 years, and into two treatment groups for type 1 diabetes, namely <5 years disease duration and >15 years disease duration. Self-reported (mild and severe) and biochemical episodes (interstitial glucose <2.2 mmol/l using continuous glucose monitoring) were recorded. Results Mild hypoglycaemia in type 2 diabetic patients on insulin for <2 years was less frequent than in type 1 patients with <5 years disease duration (mean rate: 4 vs 36 episodes per subject-year, p<0.001). In type 2 diabetic patients treated with sulfonylureas or insulin for <2 years, no differences were observed in the proportion experiencing severe hypoglycaemia (7 vs 7%, difference 0 [95% CI: −7to 9%]), mild symptomatic (39 vs 51%, difference 12 [−3 to 25%]) or interstitial glucose <2.2 mol/l (22 vs 20%, difference 2 [−13 to 10%]). Severe hypoglycaemia rates were comparable in patients with type 2 diabetes on sulfonylureas or insulin < 2 years (0.1 and 0.2 episodes per subject-year) and far less frequent than in type 1 diabetes (<5 years group, 1.1; >15 years group, 3.2. episodes per subject-year). Conclusions/interpretation During early insulin use in type 2 diabetes, the frequency of hypoglycaemia is generally equivalent to that observed in patients treated with sulfonylureas and considerably lower than during the first 5 years of treatment in type 1 diabetes.

show abstract

Section: Discussionsupporting

confidence: 57%

Section: Not Eligible N=35mentioning

confidence: 99%

Risk of hypoglycaemia in types 1 and 2 diabetes: effects of treatment modalities and their duration

2007

Diabetologia

749

259

View full text Add to dashboard Cite

show abstract

“…4 Figure 1 shows that, compared with a lower hypoglycaemia cut-off point, such as <3.1 mmol/l, the ADA definition of 3.9 mmol/l more than doubled the percentage of affected patients across a wide range of HbA 1c strata, e.g. from 17.7 to 43.3% at HbA 1c of about 7%.…”

Section: Resultsmentioning

confidence: 99%

“…However, this under-recognition was minimised by repeated discussion of hypoglycaemia symptomatology during the clinic visits. Finally, the presence of hypoglycaemia unawareness, which was not formally assessed, could have confounded our results because this is associated with an increased frequency of (severe) hypoglycaemia but fewer selfreported events [4,5]. However, hypoglycaemia unawareness is rare in patients with type 2 diabetes recently initiated on basal insulin therapy.…”

Section: Discussionmentioning

confidence: 97%

Changing the glucose cut-off values that define hypoglycaemia has a major effect on reported frequencies of hypoglycaemia

et al. 2008

View full text Add to dashboard Cite

Aims/hypothesis The aim of this analysis was to quantify the relationship between the frequency of hypoglycaemia and various glucose cut-off points for the definition of hypoglycaemia, within a range of HbA 1c strata. Methods Data from two trials examining insulin glargine dose titration in 12,837 type 2 diabetic participants starting insulin therapy were combined. Curves for hypoglycaemia frequency plotted against endpoint HbA 1c level were constructed, using a range of glucose cut-off points for hypoglycaemia. Results During the 12-week study period, 3,912 patients recorded 21,592 hypoglycaemic episodes, comprising 242 severe, 8,871 symptomatic and 12,479 asymptomatic events, corresponding to hypoglycaemia event rates of 0.10, 3.8 and 5.3 events per patient year. Increasing the hypoglycaemia cutoff point from, for instance, <3.1 to <3.9 mmol/l more than doubled the percentage of affected patients, e.g. from 17.7 to 43.3% at HbA 1c 7.0-7.2%. At higher hypoglycaemia cut-off points the proportion of patients having only asymptomatic hypoglycaemia increased, e.g. from 30.7% at <3.1 mmol/l to 61.7% of patients at a cut-off point of <3.9 mmol/l. In sensitivity analysis, 121 of 1,756 patients with at least one self-monitored blood glucose value <3.1 mmol/l experienced severe hypoglycaemia, compared with 149 of 3,912 patients with a self-monitored blood glucose level of <3.9 mmol/l. Thus, to identify 28 more patients with severe hypoglycaemia, the number of patients experiencing only non-severe hypoglycaemia more than doubled. Conclusions/interpretation The glucose cut-off point defining hypoglycaemia greatly affects the reported frequency of hypoglycaemia. When hypoglycaemia is to be defined by a predetermined glucose level, to have clinical relevance the cut-off should be set at a lower level than the threshold of 3.9 mmol/l proposed by the American Diabetes Association.

show abstract

“…Oral glucose was associated with a reduction in the early adrenaline response to hypoglycaemia, the area under the curve from 90 to 110 min falling from 24.02±20.84 (means ± SD) to 15. vere hypoglycaemia during the pharmacological treatment of diabetes mellitus. The inability to generate or detect the warning symptoms of early hypoglycaemia puts diabetic patients at high risk of episodes of severe hypoglycaemia [1] and often the fear of hypoglycaemia limits the optimisation of glycaemic control [2]. Associated with loss of subjective awareness of hypoglycaemia is a lowering of the glucose concentration required to initiate the counterregulatory response to hypoglycaemia, as well as a reduction in the magnitude and intensity of the counterregulatory response at any given blood glucose concentration [3,4,5].…”

Section: Introductionmentioning

confidence: 99%

The role of hepatic portal glucose sensing in modulating responses to hypoglycaemia in man

et al. 2002

View full text Add to dashboard Cite

Aims/hypothesis. The role of glucose sensing cells in the human hepatic portal system in the initiation of the neuroendocrine responses to acute hypoglycaemia is not known. We investigated the effect of raising blood glucose concentrations in the hepatic-portal vein on neurohumoral responses during induction of systemic hypoglycaemia in nine healthy male volunteers. Methods. Each subject received an insulin infusion (3 mU·kg -1 ·min -1 ) on two occasions, in random order. Variable rate glucose infusion was used to maintain plasma glucose at 5 mmol/l for 60 min, then 3.2 mmol/l for 60 min. At 20 min prior to hypoglycaemia, subjects drank 20 g of glucose in water or water sweetened with saccharin. In five of the volunteers, the oral glucose was labelled with U-13C6 glucose, which showed peak systemic glucose absorption between 90 and 110 min. Five volunteers also repeated the study with a euglycaemic clamp.Results. Oral glucose was associated with a reduction in the early adrenaline response to hypoglycaemia, the area under the curve from 90 to 110 min falling from 24.02±20.84 (means ± SD) to 15. vere hypoglycaemia during the pharmacological treatment of diabetes mellitus. The inability to generate or detect the warning symptoms of early hypoglycaemia puts diabetic patients at high risk of episodes of severe hypoglycaemia [1] and often the fear of hypoglycaemia limits the optimisation of glycaemic control [2]. Associated with loss of subjective awareness of hypoglycaemia is a lowering of the glucose concentration required to initiate the counterregulatory response to hypoglycaemia, as well as a reduction in the magnitude and intensity of the counterregulatory response at any given blood glucose concentration [3,4,5]. The speculation that these defects are principally the result of defective glucose sensing gains support from data showing similar changes in the neuroendocrine rePerception of a minor decrease in plasma glucose concentration and initiation of a counterregulatory response are essential factors in the defence against se-

show abstract

Frequency of Severe Hypoglycemia in Patients With Type I Diabetes With Impaired Awareness of Hypoglycemia

Abstract: This prospective evaluation demonstrated that impaired awareness of hypoglycemia predisposes to a sixfold increase in the frequency of severe hypoglycemia, much of which occurred at home during waking hours.

Cited by 699 publications

References 21 publications

Risk of hypoglycaemia in types 1 and 2 diabetes: effects of treatment modalities and their duration

Risk of hypoglycaemia in types 1 and 2 diabetes: effects of treatment modalities and their duration

Changing the glucose cut-off values that define hypoglycaemia has a major effect on reported frequencies of hypoglycaemia

The role of hepatic portal glucose sensing in modulating responses to hypoglycaemia in man

Contact Info

Product

Resources

About