Incidence of and risk factors for severe hypoglycaemia in treated type 2 diabetes mellitus patients in the UK – a nested case–control analysis

Bruderer, Saskia Gabriela; Bodmer, Michael; Jick, Susan S.; Bader, Giovanni; Schlienger, Raymond G.; Meier, Christoph

doi:10.1111/dom.12282

Cited by 44 publications

(35 citation statements)

References 42 publications

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“…In contrast, the independent determinants of severe hypoglycemia were older age, limited education, hypertension, renal insufficiency, and mild cognitive impairment. These observations are also consistent with those of other reports (5,(13)(14)(15)(16)(17). Stated in clinically relevant terms, these analyses suggest that an individual with a BMI of 25 kg/m 2 would be ;30% more likely to have nonsevere hypoglycemia than one with a BMI of 35 kg/m 2 , but with no difference in the risk of severe hypoglycemia.…”

Section: Discussionsupporting

confidence: 91%

Predictors of Nonsevere and Severe Hypoglycemia During Glucose-Lowering Treatment With Insulin Glargine or Standard Drugs in the ORIGIN Trial

Investigators¹

2014

Diabetes Care

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OBJECTIVEHypoglycemia is a leading risk of glucose-lowering therapy. Treatment with insulin glargine compared with standard care early in the course of dysglycemia in the Outcome Reduction with an Initial Glargine Intervention (ORIGIN) trial provides information on the frequency and predictors of hypoglycemia in this setting. RESEARCH DESIGN AND METHODSA total of 12,537 people with high cardiovascular risk and dysglycemia treated with one or no oral glucose-lowering agents were randomized to add glargine titrated to a fasting glucose level of £5.3 mmol/L (£95 mg/dL) or to use standard therapies. Independent associations of both nonsevere hypoglycemia (symptomatic and confirmed with a glucose level of £3 mmol/L [£54 mg/dL]) and severe hypoglycemia with characteristics at baseline, treatment allocation, and average HbA 1c were assessed by Cox proportional hazards models. RESULTSDuring a median follow-up period of 6.2 years, 28% of participants reported nonsevere hypoglycemia, and 3.8% reported severe hypoglycemia. Prior use of a sulfonylurea and allocation to glargine independently predicted a higher risk for both categories of participants. Nonsevere events were independently associated with younger age, lower BMI, the presence of diabetes, and higher baseline HbA 1c level. Severe events were associated with older age, hypertension, higher serum creatinine level, and lower cognitive function, but not baseline glycemic status. Progressively higher on-treatment HbA 1c level was associated with a lower risk of nonsevere events in both treatment groups; a lower risk of severe events in the glargine group, and a higher risk of severe events with standard care. CONCLUSIONSHypoglycemia was relatively uncommon in the ORIGIN trial, but was more frequent with sulfonylurea use at baseline and allocation to glargine. Nonsevere and severe events were associated with different clinical characteristics, awareness of which may guide individualized therapy. Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered.The ORIGIN Trial Investigators* 22Diabetes Care Volume 38, January 2015 CLIN CARE/EDUCATION/NUTRITION/PSYCHOSOCIALHypoglycemia is an important adverse effect of treatment with glucose-lowering agents such as insulin and sulfonylureas. Although only a subset of patients to whom these agents are prescribed experience hypoglycemia, these episodes limit the level of glycemic control that can be achieved, affect quality of life, and may lead to loss of consciousness and hospitalization. Moreover, epidemiologic studies have shown that people who experience hypoglycemic events are also at increased risk of a wide range of adverse health consequences including cardiovascular (CV) events, cancers, and death (1-5). Whether nonsevere and severe hypoglycemia occur in similar settings and require similar preventive tactics is unclear. These observations highlight the importance of identifying clinical characteristics that are associated with a higher ri...

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Section: Discussionsupporting

confidence: 91%

Predictors of Nonsevere and Severe Hypoglycemia During Glucose-Lowering Treatment With Insulin Glargine or Standard Drugs in the ORIGIN Trial

Investigators¹

2014

Diabetes Care

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“…Nevertheless, reasons and clinical circumstances for SH may be multifactorial and complex. Apart from the established individual risk factors such as age, diabetes duration, mode of therapy, comorbidity, comedication, impaired awareness of hypoglycemia, physical activity or alcohol consumption (Bruderer et al, 2014;Holstein et al, 2012;Pedersen-Bjergaard et al, 2004), further predisposing conditions could be of clinical relevance.…”

Section: Introductionmentioning

confidence: 99%

Accumulation of severe hypoglycemia at weekends and in warm seasons in patients with type 1 diabetes but not with type 2 diabetes

Holstein

Wohland

Patzer

et al. 2016

Journal of Diabetes and its Complications

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“…Severe hypoglycaemia was found to be prevalent in almost half of people with long-duration type 1 diabetes. 32 A retrospective cohort study by Bruderer et al 33 found severe hypoglycaemia was recorded in 12 cases per 10 000 person-years in patients with type 2 diabetes in the United Kingdom who were newly treated with anti-diabetic drugs.…”

Section: Introductionmentioning

confidence: 99%

Action on diabetic macular oedema: achieving optimal patient management in treating visual impairment due to diabetic eye disease

Gale

Scanlon

Evans

et al. 2017

Eye

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This paper identifies best practice recommendations for managing diabetes and sight-threatening diabetic eye disease. The authors provide an update for ophthalmologists and allied healthcare professionals on key aspects of diabetes management, supported by a review of the pertinent literature, and recommend practice principles for optimal patient management in treating visual impairment due to diabetic eye disease. In people with diabetes, early optimal glycaemic control reduces the long-term risk of both microvascular and macrovascular complications. The authors propose more can and should be done to maximise metabolic control, promote appropriate behavioural modifications and encourage timely treatment intensification when indicated to ameliorate diabetes-related complications. All people with diabetes should be screened for sight-threatening diabetic retinopathy promptly and regularly. It is shown that attitudes towards treatment adherence in diabetic macular oedema appear to mirror patients' views and health behaviours towards the management of their own diabetes. Awareness of diabetic macular oedema remains low among people with diabetes, who need access to education early in their disease about how to manage their diabetes to delay progression and possibly avoid eye-related complications. Ophthalmologists and allied healthcare professionals play a vital role in multidisciplinary diabetes management and establishment of dedicated diabetic macular oedema clinics is proposed. A broader understanding of the role of the diabetes specialist nurse may strengthen the case for comprehensive integrated care in ophthalmic practice. The recommendations are based on round table presentations and discussions held in London, UK, September 2016.

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Incidence of and risk factors for severe hypoglycaemia in treated type 2 diabetes mellitus patients in the UK – a nested case–control analysis

Abstract: Severe hypoglycaemia was recorded in 12 cases per 10,000 PYs. Risk factors for severe hypoglycaemia included increasing age, renal failure, cognitive impairment/dementia, and current use of insulin or sulphonylureas.

Cited by 44 publications

References 42 publications

Predictors of Nonsevere and Severe Hypoglycemia During Glucose-Lowering Treatment With Insulin Glargine or Standard Drugs in the ORIGIN Trial

Predictors of Nonsevere and Severe Hypoglycemia During Glucose-Lowering Treatment With Insulin Glargine or Standard Drugs in the ORIGIN Trial

Accumulation of severe hypoglycemia at weekends and in warm seasons in patients with type 1 diabetes but not with type 2 diabetes

Action on diabetic macular oedema: achieving optimal patient management in treating visual impairment due to diabetic eye disease

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