Rates and predictors of hypoglycaemia in 27 585 people from 24 countries with insulin‐treated type 1 and type 2 diabetes: the global <scp>HAT</scp> study

Khunti, Kamlesh; Alsifri, Saud; Aronson, Ronnie; Berković, Maja Cigrovski; Enters-Weijnen, Catherine F; Forsén, Tom; Galstyan, Gagik R.; Geelhoed-Duijvestijn, Petronella; Goldfracht, Margalit; Gydesen, Helge; Kapur, Rahul; Lalić, Nebojša; Ludvik, Bernhard; Moberg, Erik; Pedersen‐Bjergaard, Ulrik; Ramachandran, Ambady

doi:10.1111/dom.12689

Cited by 233 publications

(300 citation statements)

References 28 publications

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“…The higher rates displayed in Central and South American countries confirm the findings from a recent observational analysis (Hypoglycaemia Assessment Tool study), which reported a twofold greater risk of severe hypoglycaemia in individuals living in Argentina and Mexico [31]. On the other hand, our results for Asian countries were mixed and fewer data on the risk of hypoglycaemia in Asian populations are currently available.…”

Section: Discussionsupporting

confidence: 70%

Global burden of hypoglycaemia-related mortality in 109 countries, from 2000 to 2014: an analysis of death certificates

et al. 2018

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Aims/hypothesis In the context of increasing prevalence of diabetes in elderly people with multimorbidity, intensive glucose control may increase the risk of severe hypoglycaemia, potentially leading to death. While rising trends of severe hypoglycaemia rates have been reported in some European, North American and Asian countries, the global burden of hypoglycaemia-related mortality is unknown. We aimed to investigate global differences and trends of hypoglycaemia-related mortality. Methods We used the WHO mortality database to extract information on death certificates reporting hypoglycaemia or diabetes as the underlying cause of death, and the United Nations demographic database to obtain data on mid-year population estimates from 2000 to 2014. We calculated crude and age-standardised proportions (defined as number of hypoglycaemia-related deaths divided by total number of deaths from diabetes [i.e. the sum of hypoglycaemia-and diabetes-related deaths]) and rates (hypoglycaemia-related deaths divided by mid-year population) of hypoglycaemia-related mortality and compared estimates across countries and over time.Results Data for proportions were extracted from 109 countries (31 had data from all years analysed [2000][2001][2002][2003][2004][2005][2006][2007][2008][2009][2010][2011][2012][2013][2014] available). Combining all countries, the age-standardised proportion of hypoglycaemia-related deaths was 4.49 (95% CI 4.44, 4.55) per 1000 total diabetes deaths. Compared with the overall mean, most Central American, South American and (mainly) Caribbean countries reported higher proportions (five more age-standardised hypoglycaemia-related deaths per 1000 total diabetes deaths in Chile, six in Uruguay, 11 in Belize and 22 in Aruba), as well as Japan (11 more age-standardised hypoglycaemia-related deaths per 1000 total diabetes deaths). In comparison, lower proportions were noted in most European countries, the USA, Canada, New Zealand and Australia. For countries with data available for all years analysed, trend analysis showed a 60% increase in hypoglycaemia-related deaths until 2010 and stable trends onwards. Rising trends were most evident for Argentina, Brazil, Chile, the USA and Japan. Data for rates were available for 105 countries (30 had data for all years analysed [2000][2001][2002][2003][2004][2005][2006][2007][2008][2009][2010][2011][2012][2013][2014] available). Combining all countries, the age-standardised hypoglycaemia-related death rate was 0.79 (95% CI 0.77, 0.80) per 1 million person-years. Most Central American, South American and Caribbean countries similarly reported higher rates of hypoglycaemia-related death, whilst virtually all European countries, the USA, Canada, Japan, New Zealand and Australia reported lower rates compared with the overall mean. Age-standardised rates were very low for most countries (lower than five per 1 million person-years in 89.5% of countries), resulting in small absolute differences among countries. As noted with the proportions analysis, trend analysis sho...

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Section: Discussionsupporting

confidence: 70%

Global burden of hypoglycaemia-related mortality in 109 countries, from 2000 to 2014: an analysis of death certificates

et al. 2018

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“…20 Furthermore, the slight difference in diabetes duration between responders and nonresponders may indicate that subjects with a higher hypoglycaemia risk may have been more inclined to respond since a longer duration has been shown to be associated with risk of hypoglycaemia in previous studies. 2 To conclude, this study shows that FoH is persistent over time if not treated and that hypoglycaemia frequency is the strongest predictor of FoH. Thus, asking patients about the occurrence of hypoglycaemia is of the utmost importance as is helping them adequately detect, prevent and treat hypoglycaemia.…”

Section: F I G U R E 1 Each Participant's Individual Scores On Hypoglmentioning

confidence: 66%

“…5 Past experience of SH is associated with greater fear of hypoglycaemia (FoH) in individuals with type 1 diabetes, suggesting that the experience of hypoglycaemia plays an important role in triggering FoH. 2,[6][7][8][9] FoH is recognized as a complex and common phenomenon affecting quality of life and diabetes management for individuals with type 1 diabetes. 9 Furthermore, worries about hypoglycaemia are also common in family members.…”

mentioning

confidence: 99%

A longitudinal study of fear of hypoglycaemia in adults with type 1 diabetes

Anderbro

Amsberg

Moberg

et al. 2018

Endocrino Diabet & Metabol

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Summary Aims To investigate fear of hypoglycaemia (FoH) longitudinally in a cross‐sectional study of adult patients with type 1 diabetes. Specifically, we investigated two subgroups of patients who over 4 years either showed a substantial increase or decrease in level of FoH to identify factors associated with changes in FoH. Methods The Swedish version of the Hypoglycaemia Fear Survey (HFS) along with a questionnaire to assess hypoglycaemia history was sent by mail to 764 patients in 2010. The responders in 2010 (n = 469) received another set of the same two questionnaires in 2014. HbA1c, insulin regimen, weight and creatinine from 2010 and 2014 were obtained from medical records. Those with an absolute difference in HFS scores ≥ 75th percentile were included in the subgroup analyses. Statistical analyses included one‐sample t tests, chi‐square and McNemar's test. Results The absolute difference in the HFS total score (n = 347) between 2010 and 2014 was m = ±7.6, SD ± 6. In the increased FoH group, more patients reported a high level of moderate hypoglycaemic episodes as well as impaired awareness of hypoglycaemia in 2014 compared with the decreased FoH group. There were more subjects in the increased FoH group with insulin pumps in 2014 and in 2010. In the decreased FoH group, more patients had a high frequency of daily self‐monitoring of blood glucose (SMBG) in 2010 and in 2014. Conclusions Fear of hypoglycaemia is stable across time for most patients. Changes in fear level are associated with changes in hypoglycaemia frequency. Thus, asking patients about changes in hypoglycaemia experiences is of great importance.

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“…The study population in Northern Europe/Canada had a longer disease duration and had used insulin for longer than the other regions, which might influence the level of hypoglycaemia awareness. For the overall HAT study population, HbA 1c was not found to be a significant predictor of hypoglycaemia 13. However, in people with Type 2 diabetes, the higher blood glucose cut‐off for defining hypoglycaemia occurred in regions with a higher mean HbA 1c (Middle East, Russia and South East Asia), perhaps suggesting that these participants experience hypoglycaemia at higher blood glucose levels.…”

Section: Discussionmentioning

confidence: 84%

Regional variations in definitions and rates of hypoglycaemia: findings from the global HAT observational study of 27 585 people with Type 1 and insulin‐treated Type 2 diabetes mellitus

et al. 2018

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AimTo determine participant knowledge and reporting of hypoglycaemia in the non‐interventional Hypoglycaemia Assessment Tool (HAT) study.Methods HAT was conducted in 24 countries over a 6‐month retrospective/4‐week prospective period in 27 585 adults with Type 1 or insulin‐treated Type 2 diabetes mellitus. Participants recorded whether hypoglycaemia was based on blood glucose levels, symptoms or both.ResultsHypoglycaemia rates were consistently higher in the prospective compared with the retrospective period. Most respondents (96.8% Type 1 diabetes; 85.6% Type 2 diabetes) knew the American Diabetes Association/European Association for the Study of Diabetes hypoglycaemia definition, but there were regional differences in the use of blood glucose measurements and/or symptoms to define events. Confirmed symptomatic hypoglycaemia rates were highest in Northern Europe/Canada for Type 1 diabetes (63.9 events/year) and in Eastern Europe for Type 2 diabetes (19.4 events/year), and lowest in South East Asia (Type 1 diabetes: 6.0 events/year; Type 2 diabetes: 3.2 events/year). Unconfirmed symptomatic hypoglycaemia rates were highest in Eastern Europe for Type 1 diabetes (5.6 events/year) and South East Asia for Type 2 diabetes (4.7 events/year), and lowest for both in Russia (Type 1 diabetes: 2.1 events/year; Type 2 diabetes: 0.4 events/year). Participants in Latin America reported the highest rates of severe hypoglycaemia (Type 1 diabetes: 10.8 events/year; Type 2 diabetes 3.7 events/year) and severe hypoglycaemia requiring hospitalization (Type 1 diabetes: 0.56 events/year; Type 2 diabetes: 0.44 events/year). The lowest rates of severe hypoglycaemia were reported in South East Asia (Type 1 diabetes: 2.0 events/year) and Northern Europe/Canada (Type 2 diabetes: 1.3 events/year), and the lowest rates of severe hypoglycaemia requiring hospitalization were in Russia (Type 1 diabetes: 0.15 events/year; Type 2 diabetes: 0.09 events/year). The blood glucose cut‐off used to define hypoglycaemia varied between regions (Type 1 diabetes: 3.1–3.6 mmol/l; Type 2 diabetes: 3.5–3.8 mmol/l).ConclusionsUnder‐reporting of hypoglycaemia rates in retrospective recall and regional variations in participant definitions of hypoglycaemia may contribute to the global differences in reported rates. Discrepancies between participant definitions and guidelines may highlight a need to redefine hypoglycaemia criteria. (Clinical Trials Registry No: NCT01696266).

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Rates and predictors of hypoglycaemia in 27 585 people from 24 countries with insulin‐treated type 1 and type 2 diabetes: the global HAT study

Cited by 233 publications

References 28 publications

Global burden of hypoglycaemia-related mortality in 109 countries, from 2000 to 2014: an analysis of death certificates

Global burden of hypoglycaemia-related mortality in 109 countries, from 2000 to 2014: an analysis of death certificates

A longitudinal study of fear of hypoglycaemia in adults with type 1 diabetes

Regional variations in definitions and rates of hypoglycaemia: findings from the global HAT observational study of 27 585 people with Type 1 and insulin‐treated Type 2 diabetes mellitus

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