Hypoglycemia incidence and awareness among insulin-treated patients with diabetes: the HAT study in Brazil

Abstract

BackgroundHypoglycemia affects patient safety and glycemic control during insulin treatment of both type 1 (T1DM) and type 2 diabetes mellitus (T2DM). The Hypoglycemia Assessment Tool study in Brazil aimed to determine the proportion of patients experiencing hypoglycemic events and to characterize patient awareness and fear about hypoglycemia, among insulin-treated T1DM or T2DM patients.MethodsThis was a non-interventional, multicenter study, with a 6-month retrospective and a 4-week prospective evaluation of hypoglycemic events. Patients completed a questionnaire at baseline and at the end of the study, and also a patient diary. The answers ‘occasionally’ and ‘never’ to the question ‘Do you have symptoms when you have a low sugar level?’ denoted impaired hypoglycemia awareness. Fear was reported on a 10-point scale, from ‘not afraid at all’ to ‘absolutely terrified’.ResultsFrom 679 included patients, 321 with T1DM and 293 T2DM, median age of 33.0 and 62.0 years, 59% and 56% were female, and median diabetes duration was 15.0 and 15.0 years, respectively. Median time of insulin use was 14.0 and 6.0 years. During the prospective period, 91.7% T1DM and 61.8% T2DM patients had at least one hypoglycemic event. In the same period, 54.0% T1DM and 27.4% T2DM patients had nocturnal hypoglycemia, 20.6% T1DM and 10.6% T2DM patients had asymptomatic hypoglycemia, and severe events occurred in 20.0% and 10.3%, respectively. At baseline, 21.4% T1DM and 34.3% T2DM had hypoglycemia unawareness. The mean score of hypoglycemia fear was 5.9 ± 3.1 in T1DM and 5.4 ± 3.9 in T2DM. The most common attitude after hypoglycemic events were to increase calorie intake (60.3%) and blood glucose monitoring (58.0%) and to reduce or skip insulin doses (30.8%).ConclusionsReferred episodes of hypoglycemia were high, in both T1DM and T2DM insulin users. Patient attitudes after hypoglycemia, such as reduction in insulin and increase in calorie intake, can affect diabetes management. These findings may support clinicians in tailoring diabetes education and insulin treatment for patients with diabetes, in order to improve their glycemic control while reducing the risk of hypoglycemic events.

Real-time CGM Is Superior to Flash Glucose Monitoring for Glucose Control in Type 1 Diabetes: The CORRIDA Randomized Controlled Trial

“…Another strength was the size and demographic composition of our cohort compared with the earlier head-to-head reports by Reddy et al ( 11 , 12 ), which compared the impact of isCGM versus rtCGM use in 40 adults with T1D with problematic hypoglycemia. Our study randomized 60 adults with T1D with normal hypoglycemia awareness, which represents ∼50–60% of the population with T1D ( 19 ).…”

The effect of eye movement desensitization and reprocessing on the fear of hypoglycemia in type 2 diabetic patients: a randomized clinical trial

“…Hypoglycemia is common in type 2 diabetic patients. According to the study by Gehlaut et al [4], at least 49.1% of patients; and according to the study conducted by Lamounier et al [5],61.8% of patients had experienced hypoglycemia. In some categorizations, hypoglycemia is categorized into trivial and severe categories.…”

Lower risk of severe hypoglycaemia with insulin glargine 300 U/mL versus glargine 100 U/mL in participants with type 1 diabetes: A meta‐analysis of 6‐month phase 3 clinical trials

“…Intensive insulin therapy to maintain glycaemic targets and reduce vascular complications exposes patients to increased risk of hypoglycaemia 1 and its negative consequences. 2,3 New-generation basal insulins may reduce the risk of hypoglycaemia and improve glycaemic control.…”