Prevalence of impaired awareness of hypoglycaemia and frequency of hypoglycaemia in insulin-treated Type 2 diabetes

Schopman, J.E.; Geddes, Jacqueline; Frier, Brian M.

doi:10.1016/j.diabres.2009.10.013

Cited by 124 publications

(100 citation statements)

References 21 publications

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“…Although randomized controlled trials will be required to determine whether meeting conventional HgbA1c targets can improve survival outcomes in this population, our results suggest that improved survival should not be used to justify aggressive glycemic control strategies. Finally, emphasis should be placed on the risks associated with hypoglycemia (35,36). Our preliminary findings indicate that risk of hypoglycemia is especially significant in diabetic ESRD patients with glycemic variability (37).…”

Section: Discussionmentioning

confidence: 99%

Glycemic Control and Extended Hemodialysis Survival in Patients with Diabetes Mellitus

Williams

Lacson²,

Wang³

et al. 2010

Clinical Journal of the American Society of Nephrology

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Background and objectives: The benefits and risks of aggressive glycemic control in diabetes mellitus complicated by end-stage kidney failure remain uncertain but have importance because of the large patient population with inferior overall prognosis. Recent large observational studies with differing methodologies reached somewhat contrasting conclusions regarding the association of hemoglobin A1c with survival in diabetic chronic hemodialysis patients.Design, setting, participants, & measurements: This study supplements the authors' previous analysis (which found no correlation) by extending the follow-up period to 3 years and using time-dependent survival models with repeated measures. Among 24,875 nationally distributed study patients, 94.5% had type 2 diabetes, allowing additional analysis in the subset with type 1 diabetes. Data were collected at baseline and every quarter to a maximum of 3 years' follow-up.Results: Adjusted standard and time-dependent Cox models indicated that only extremes of glycemia were associated with inferior survival. There was no effect modification by serum albumin levels, a marker of protein nutrition status, and no trend associated with random glucose measurements in a post hoc analysis. In type 1 diabetic patients, upper extreme hemoglobin A1c values indicated lower survival risk.Conclusions: Sustained extremes of glycemia were only variably and weakly associated with decreased survival in this population. In the absence of randomized, controlled trials, these results suggest that aggressive glycemic control cannot be routinely recommended for all diabetic hemodialysis patients on the basis of reducing mortality risk. Physicians are encouraged to individualize glycemic targets based on potential risks and benefits in diabetic ESRD patients.

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Section: Discussionmentioning

confidence: 99%

Glycemic Control and Extended Hemodialysis Survival in Patients with Diabetes Mellitus

Williams

Lacson²,

Wang³

et al. 2010

Clinical Journal of the American Society of Nephrology

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“…[10][11][12][13][14][15] A range of costs was estimated based on high and low rates of severe hypoglycemic events in insulin-using patients. A selective literature search was conducted on the effect and cost-effectiveness (where available) on A1c and hypoglycemia of insulin pumps (CSII), bolus calculators (BC), real-time continuous glucose monitors (RT-CGM), sensor-augmented pumps (SAP), low-glucose threshold suspend (LGTS) systems, low-glucose predictive suspend (LGPS) systems, and artificial pancreas (AP) systems.…”

Section: Methodsmentioning

confidence: 99%

“…They found that the cost per QALY was AUS$40 803 in patients ≥12 years. 69 Finally, Graham and colleagues, modeling the cost saving of RT-CGM using the same assumptions noted above, [10][11][12][13][14][15][16] found that RT-CGM reduced the yearly cost of hypoglycemia by 13% in a population of 10 million insured patients. 70 The cost-effectiveness of using RT-CGM in patients with type 2 diabetes not on prandial insulin was evaluated by Fonda and colleagues.…”

Section: Cost-effectivenessmentioning

confidence: 99%

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

Vigersky

2015

J Diabetes Sci Technol

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The New York Times published an article on April 5, 2014, titled "Even Small Medical Advances Can Mean Big Jumps in Bills" by Elizabeth Rosenthal, 1 claiming that diabetes technologies and therapies are overpriced, offer little value, and place an unjust burden on the US health care system. "That captive audience of Type 1 diabetics has spawned lines of high-priced gadgets and disposable accouterments, borrowing business models from technology companies like Apple." This controversial article failed to capture the benefits of technology not only in improving glycemic control as determined by hemoglobin A1c (A1c) but also in mitigating the frequency, severity, and cost of hypoglycemia. The article also did not address the increasing problem and resultant costs of hypoglycemia in patients with type 2 diabetes and how technology might be used to mitigate this as well. 2 In light of Rosenthal's article, it is important to objectively review the literature to answer the following questions: 1. What is the cost of hypoglycemia? 2. What is the evidence that technology can improve A1c and/or reduce the risk of hypoglycemia? 3. What are the limitations in using technology to accomplish this? 4. What is the cost-effectiveness of technology? 5661D STXXX10.

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“…It should be noted that all analyses were made with those five participants included and excluded, with similar results being obtained (in the reported analyses, these five participants have been included). It is possible that hypoglycemia was under-reported, which would reduce the strength of an association, although the clinical syndrome of impaired hypoglycemia awareness that is associated with severe hypoglycemia is relatively uncommon in people with insulin-treated type 2 diabetes (29).…”

Section: Study Strengths and Limitationsmentioning

confidence: 99%

Association Between Severe Hypoglycemia, Adverse Macrovascular Events, and Inflammation in the Edinburgh Type 2 Diabetes Study

et al. 2014

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OBJECTIVETo determine whether a history of severe hypoglycemia was associated with an increased risk of subsequent macrovascular events in people with type 2 diabetes and to explore possible mediation of this association by inflammation. RESEARCH DESIGN AND METHODSA cohort of 1,066 adults aged 60-75 years with type 2 diabetes was evaluated prospectively. Baseline history of severe hypoglycemia and plasma levels of the inflammatory markers C-reactive protein, fibrinogen, interleukin-6, and tumor necrosis factor-a were recorded. Their association with incident macrovascular events after 4 years was explored. RESULTSAt baseline, 87 participants (8.2%) reported one or more episodes of severe hypoglycemia within the preceding year, and at follow-up 99 participants (9.3%) had suffered a new macrovascular event. Hypoglycemia was associated with increased odds of macrovascular events (odds ratio [OR] 2.11 [95% CI 1.06, 4.21], P = 0.035), including coronary heart events (OR 2.44 [95% CI 1.13, 5.26], P = 0.023), largely due to increased myocardial infarction (OR 4.02 [95% CI 1.54, 10.48], P = 0.004). Hypoglycemia was also associated with increased levels of inflammatory markers, including a general inflammation factor derived using principalcomponents analysis (P = 0.030, after adjustment for cardiometabolic risk factors). However, the significant association between hypoglycemia and macrovascular events persisted after adjustment for inflammatory markers. CONCLUSIONSThe odds of suffering a macrovascular event were higher in patients with type 2 diabetes who had a history of severe hypoglycemia. There was no evidence that a proinflammatory state had a major role in mediating this association.Macrovascular disease is the major cause of mortality in people with type 2 diabetes (1). Hypoglycemia is a potentially serious side effect of insulin and sulfonylureas when used to treat diabetes (2). It is associated with significant morbidity and mortality and can provoke acute cardiovascular and cerebrovascular events (2-4). Hypoglycemia may also have a role in aggravating other chronic complications (4)

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Prevalence of impaired awareness of hypoglycaemia and frequency of hypoglycaemia in insulin-treated Type 2 diabetes

Cited by 124 publications

References 21 publications

Glycemic Control and Extended Hemodialysis Survival in Patients with Diabetes Mellitus

Glycemic Control and Extended Hemodialysis Survival in Patients with Diabetes Mellitus

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

Association Between Severe Hypoglycemia, Adverse Macrovascular Events, and Inflammation in the Edinburgh Type 2 Diabetes Study

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