HbA1c and Risk of Severe Hypoglycemia in Type 2 Diabetes

Abstract

OBJECTIVEWe examined the association between HbA1c level and self-reported severe hypoglycemia in patients with type 2 diabetes.RESEARCH DESIGN AND METHODSType 2 diabetic patients in a large, integrated healthcare system, who were 30–77 years of age and treated with glucose-lowering therapy, were asked about severe hypoglycemia requiring assistance in the year prior to the Diabetes Study of Northern California survey conducted in 2005–2006 (62% response rate). The main exposure of interest was the last HbA1c level collected in the year preceding the observation period. Poisson regression models adjusted for selected demographic and clinical variables were specified to evaluate the relative risk (RR) of severe hypoglycemia across HbA1c levels. We also tested whether the HbA1c-hypoglycemia association differed across potential effect modifiers (age, diabetes duration, and category of diabetes medication).RESULTSAmong 9,094 eligible survey respondents (mean age 59.5 ± 9.8 years, mean HbA1c 7.5 ± 1.5%), 985 (10.8%) reported experiencing severe hypoglycemia. Across HbA1c levels, rates of hypoglycemia were 9.3–13.8%. Compared with those with HbA1c of 7–7.9%, the RR of hypoglycemia was 1.25 (95% CI 0.99–1.57), 1.01 (0.87–1.18), 0.99 (0.82–1.20), and 1.16 (0.97–1.38) among those with HbA1c <6, 6–6.9, 8–8.9, and ≥9%, respectively, in a fully adjusted model. Age, diabetes duration, and category of diabetes medication did not significantly modify the HbA1c-hypoglycemia relationship.CONCLUSIONSSevere hypoglycemia was common among patients with type 2 diabetes across all levels of glycemic control. Risk tended to be higher in patients with either near-normal glycemia or very poor glycemic control.

The Benefits, Limitations, and Cost-Effectiveness of Advanced Technologies in the Management of Patients With Diabetes Mellitus

“…The highest incidence was in those with the highest A1cs and was not related to whether or not the patient was on insulin, insulin plus an oral agent, or oral agents alone. 7 These observations and others have led the Endocrine Society and the American Diabetes Association to recommend that for "healthy adults with diabetes, a reasonable glycemic goal might be the lowest A1c that does not cause severe hypoglycemia, preserves awareness of hypoglycemia, and results in an acceptable number of documented episodes of symptomatic hypoglycemia." 8 The recent reduction of A1c goals in children and young adults with type 1 diabetes to <7.5% exert more pressure on finding a way to achieve those goals.…”

Ocena częstości występowania hipoglikemii w zależności od aktywności fizycznej

“…For the assessment of hypoglycaemia incidence, a classification based on clinical data similar to those used in most of the studies, and thus it seems that in this survey the probability of overestimating hypoglycaemia incidence is negligible [22][23][24][25].…”

Continuous Glucose Monitoring with Multiple Daily Insulin Treatment: Outcome Studies

“…The rate of hypoglycemia in type 2 diabetes is higher than usually appreciated. [57][58][59] For example Lipska et al reported that 10.8% of patients in the large database experienced severe hypoglycemia. 59 Gehlaut et al found that 49% of patients with type 2 diabetes in their study had at least one episode of hypoglycemia during a 5-day analysis with CGM and many of those hypoglycemic episodes were asymptomatic.…”

“…[57][58][59] For example Lipska et al reported that 10.8% of patients in the large database experienced severe hypoglycemia. 59 Gehlaut et al found that 49% of patients with type 2 diabetes in their study had at least one episode of hypoglycemia during a 5-day analysis with CGM and many of those hypoglycemic episodes were asymptomatic. 58 They also found that 21% of those patients found to have hypoglycemia had values <50 mg/dL and episodes were most common in those on insulin.…”