Incidence and predictors of hypoglycaemia in type 2 diabetes – an analysis of the prospective DiaRegis registry

Abstract

BackgroundHypoglycaemia is a serious adverse effect of antidiabetic drug therapy. We aimed to determine incidence rates of hypoglycaemia in type-2 diabetic patients and identify predictors of hypoglycaemia when treatment is intensified.MethodsDiaRegis is a prospective German registry that follows 3810 patients with type-2 diabetes referred for treatment intensification because of insufficient glycaemic control on one or two oral antidiabetic drugs.ResultsOut of a total of 3347 patients with data available for the present analysis 473 (14.1%) presented any severity hypoglycaemia over a follow-up of 12 months. 0.4% were hospitalized (mean of 1.3±0.6 episodes), 0.1% needed medical assistance (1.0±0.0), 0.8% needed any help (1.1±0.5) and 10.1% no help (3.4±3.7), and 8.0% had no specific symptoms (3.6±3.5). Patients with incident hypoglycaemia had longer diabetes duration, higher HbA1c and a more frequent smoking history; more had co-morbid disease conditions such as coronary artery disease, peripheral arterial disease, amputation, heart failure, peripheral neuropathy, diabetic retinopathy and clinically relevant depression at baseline. Multivariable adjusted positive predictors of incident hypoglycaemia over the follow-up were prior anamnestic hypoglycaemia, retinopathy, depression, insulin use and blood glucose self-measurement, but not sulfonylurea use as previously reported for anamnestic or recalled hypogylcaemia. On the contrary, glitazones, DPP-4 inhibitors and GLP-1 analogues were associated with a reduced risk of hypoglycaemia.ConclusionsHypoglycaemia is a frequent adverse effect in ambulatory patients when antidiabetic treatment is intensified. Particular attention is warranted in patients with prior episodes of hypoglycaemia, microvascular disease such as retinopathy and in patients receiving insulin. On the other hand glitazones, DPP-4 inhibitors and GLP-1 analogues are associated with a reduced risk.

Hypoglycemia in Older People - A Less Well Recognized Risk Factor for Frailty

“…Of the cases attributed to insulin, 95.4% were due to hypoglycemia, 24.1% involved loss of consciousness or seizure, and 25.1% required hospitalization [13]. More recently in a prospective study of DiaRegis (multicenter registry of patients with diabetes) in Germany of 3,347 patients (median age 66.1 years), the incidence of hypoglycemia of any severity was 14.1% over 12 months of follow up [14]. Although hypoglycemia incidence is difficult to accurately estimate, it is likely to be higher in older than younger people.…”

The best hypoglycaemia avoidance initiative in the UK

“…The National Diabetes Inpatient Audit (NaDIA) conducted on a single day has shown that 20% of inpatients with diabetes experience mild hypoglycaemia with capillary blood glucose (CBG) 3.0-3.9 mmol/L and 10% of patients have severe hypoglycaemia with CBG <3.0 mmol/L. 1 It is difficult to compare this with the frequency of hypoglycaemia in the community, but the prevalence of hypoglycaemia in population-based studies has been reported as 11-14% in a year, 2 and can be as high as 96% if the period of survey is extended to any time in the past. 3 Since the first NaDIA, a number of attempts such as e-learning modules, the 'Think Glucose' programme, education of junior doctors regarding hypoglycaemia during their induction and modifications in the prescription charts have been made to reduce inpatient hypoglycaemia.…”

Incidence, characteristics and impact of hypoglycaemia in patients receiving intensified treatment for inadequately controlled type 2 diabetes mellitus

“…11 In the present analysis, the relationship between incident hypoglycaemia and the diagnosis of new comorbidities during the 2-year follow-up period was explored. Hypoglycaemic episodes were reported by 17.8% of the patients (11.4% per year), and hypoglycaemia was associated with an increased risk of micro-and macrovascular events.…”