Hypoglycaemia assessment tool (HAT) study: subanalysis of the Lebanese cohort

Abstract

Background: Diabetic hypoglycaemia affects medication adherence, patients' productivity and quality of life. It is also associated with an increased risk of cardiovascular complications. Aims: To examine the impact of hypoglycaemia in insulin-treated patients in the Lebanese cohort of the Hypoglycaemia Assessment Tool (HAT) study. Methods: The HAT study was an observational study covering a 6-month retrospective and a 4-week prospective period in 24 countries including Lebanon. Data were collected using self-assessment questionnaires and patient diaries from 1158 invited lebanese patients, aged ≥ 18 years, with type 1 or type 2 diabetes mellitus (T1DM/T2DM) treated with insulin for > 12 months. The primary endpoint was the proportion of patients experiencing ≥ 1 hypoglycaemic event during the 4-week follow-up period. Results: After 4 weeks of follow-up, 177/225 [78.7%; 95% confidence interval (CI): 72.7-83.8] of patients with T1DM and 291/630 (46.2%; 95% CI: 42.2-50.2) patients with T2D experienced at least 1 hypoglycaemic event. Rates of nocturnal and severe hypoglycaemia were 10.7 (95% CI: 9.1-12.3) and 13.2 (95% CI: 11.5-14.9) events/patient-year for T1DM, and 3.3 (95% CI: 2.8-3.8) and 4.2 events/patient-year (95% CI: 3.6-4.8) for T2DM, respectively. Fear of hypoglycaemia was significantly associated with nocturnal and severe hypoglycaemia in both diabetes types (P < 0.001). Conclusion: The results suggest that the less-advanced healthcare systems in Lebanon are implicated in lower levels of patient knowledge about hypoglycaemia and related preventive measures. Treatment strategies and glycaemia goals should be individualized according to patient preference, medical benefits, and risk of hypoglycaemia.

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“…Some of them focused on the assessment of the social determinants of health and their impact on clinical outcomes in adults with T2DM 91 and others tested the effect of culturally tailored education targeting diabetes selfcare on hypoglycemia side-effect. 92 , 93 Other reviews and meta-analyses described T2DM complications, reported mortality rates, 94 and compared surgical versus non-surgical treatment options for the treatment of diabetic foot ulcers. These studies concluded that neuropathic plantar ulcers are difficult-to-heal wounds and chronicity is associated with frequent hospitalizations, higher rates of amputation, and mortality.…”

Recommendations for Early and Comprehensive Management of Type 2 Diabetes and Its Related Cardio-Renal Complications

“…A local study showed a preference for oral medication among Lebanese patients compared to injectable medication [15]. Another study emphasized the importance of the choice of agents with low risk of hypoglycemia in the Lebanese diabetic population that has a relatively high rate of hypoglycemia [66]. Therefore, to meet individualized patient goals, and to prevent treatment failure, it is crucial to initiate an oral combination therapy at the primary care level [67].…”