Relationship between HbA<sub>1c</sub> and hypoglycaemia in patients with type 2 diabetes treated with different insulin regimens in combination with metformin

Chan, John; Leyk, Małgorzata; Frier, Brian M.; Tan, Meng H.

doi:10.1002/dmrr.929

Cited by 15 publications

(6 citation statements)

References 61 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…However, the controlled environments of clinical trial settings and cohorts may not be fully applicable to real‐world patient care (11). Thus, it is unclear whether the incidence of severe hypoglycaemia is less in clinical trials than in usual clinical practice (12). For this reason, the incidence of severe hypoglycaemia with premixed insulin analogues in multicultural clinical practice remains uncertain.…”

Section: Introductionmentioning

confidence: 99%

Low risk of severe hypoglycaemia in patients with type 2 diabetes mellitus starting insulin therapy with premixed insulin analogues BID in outpatient settings

Pīrāgs

Damassy

Dąbrowski

et al. 2012

International Journal of Clinical Practice

View full text Add to dashboard Cite

Summary Aims: The choice of insulin at initiation in type 2 diabetes remains controversial. The aim of this study was to assess the occurrence of self‐reported severe hypoglycaemia associated with premixed insulin analogues in routine clinical care. Methods: A 12‐month, prospective, observational, multicentre study in patients starting a commonly prescribed premixed insulin analogue (either insulin lispro 25/75 or biphasic insulin aspart 30/70, twice daily) after suboptimal glycaemic control on oral antidiabetic agents. Treatment decisions were made solely in the course of usual practice. Results: Study follow‐up was completed by 991 (85.5%) of the 1150 patients enrolled. At baseline, mean (SD) age was 57.9 (10.1) years; mean diabetes duration was 9.2 (5.9) years; mean haemoglobin A1c (HbA1c) was 9.9 (1.8) % and the rate of severe hypoglycaemia was 0.03 episode/patient‐year. At 12 months, the rate of severe hypoglycaemia was 0.04 episode/patient‐year (95% CI 0.023, 0.055 episode/patient‐year) and mean insulin dose was 41.5 (19.4) units. Changes from baseline to 12 months for mean fasting plasma glucose and HbA1c were −5.1 mmol/l and −2.5%, respectively. Conclusions: After initiation of premixed insulin analogues in patients with type 2 diabetes in real‐world settings, the incidence of severe hypoglycaemia was lower than expected from previously reported studies.

show abstract

Section: Introductionmentioning

confidence: 99%

Low risk of severe hypoglycaemia in patients with type 2 diabetes mellitus starting insulin therapy with premixed insulin analogues BID in outpatient settings

Pīrāgs

Damassy

Dąbrowski

et al. 2012

International Journal of Clinical Practice

View full text Add to dashboard Cite

show abstract

“…In the insulin group, HbA1c was lower by 0.23% in patients experiencing hypoglycemia (95% CI 7.0%, 7.3%) than in patients who did not experience hypoglycemia (95% CI 7.3%, 7.6%). Chan et al . reported a lower HbA1c level (by 0.26%) in patients with confirmed hypoglycemia compared with patients without hypoglycemia (HbA1c 7.39% [57 mmol/mol] vs 7.64% [60 mmol/mol], respectively).…”

Section: Discussionmentioning

confidence: 99%

Dynamic risk factors associated with non‐severe hypoglycemia in patients treated with insulin glargine or exenatide once weekly 与每日一次使用甘精胰岛素或者每周一次使用艾塞那肽治疗的患者出现非严重低血糖相关的动态危险因素

Paul

Maggs

Klein

et al. 2014

Journal of Diabetes

View full text Add to dashboard Cite

show abstract

“…Chan et al., who pooled data from three randomised controlled trials comparing insulin preparations combined with metformin, demonstrated a statistically significant relationship of low HbA1c and hypoglycaemia. 29 Subjects in the UK Prospective Diabetes Study trial treated with insulins or sulphonylureas who achieved lower median HbA1c experienced more hypoglycaemia. 16 In contrast, the ACCORD study found higher HbA1c at baseline was associated with an increased risk of hypoglycaemia in both the intensive and standard treatment arms.…”

Section: Discussionmentioning

confidence: 99%

HbA1c and hypoglycaemia in intensively treated type 2 diabetes: a retrospective cohort study in primary care

et al. 2018

View full text Add to dashboard Cite

ObjectiveTo establish whether low HbA1c is associated with clinical hypoglycaemia among people with type 2 diabetes prescribed insulins or sulphonylureas.DesignRetrospective cohort study using routine electronic GP health records collected between January 2013 and December 2015.SettingThree east London Clinical Commissioning Groups.ParticipantsTwo cohorts of adults with type 2 diabetes prescribed either (i) insulins with or without other oral antidiabetic medication (n = 6788, 36.4%) or (ii) sulphonylureas with or without other oral antidiabetic medications excluding insulins (n = 11,840, 63.6%).Main outcome measuresFirst clinically recorded hypoglycaemia and all-cause mortality. Hazard ratios (HR) adjusting for age, ethnicity, renal function and comorbidities were calculated using Cox regression models.ResultsCompared with an HbA1c of 53–63 mmol/mol, the adjusted HR of hypoglycaemia in those with a low HbA1c, below 53 mmol/mol, in the insulin and sulphonylurea cohorts were 1.26 (95% CI, 0.97 to 1.62) and 1.54 (95% CI, 1.27 to 1.87), respectively. Adjusted HRs of all-cause mortality from low HbA1c in the insulin and sulphonylurea cohorts were 1.54 (95% CI, 1.15 to 2.07) and 1.42 (95% CI, 1.11 to 1.81), respectively. Increasing age and renal impairment were also associated with increased hypoglycaemic risk in both cohorts.ConclusionsHbA1c below 53 mmol/mol was associated with episodes of clinical hypoglycaemia among people with type 2 diabetes prescribed sulphonylureas, and all-cause mortality in those prescribed insulins and sulphonylureas. These findings support the need for reviewing glycaemic targets and the intensities of treatment in those with low HbA1c prescribed insulins or sulphonylureas to reduce the risk of hypoglycaemia.

show abstract

Relationship between HbA_1c and hypoglycaemia in patients with type 2 diabetes treated with different insulin regimens in combination with metformin

Cited by 15 publications

References 61 publications

Low risk of severe hypoglycaemia in patients with type 2 diabetes mellitus starting insulin therapy with premixed insulin analogues BID in outpatient settings

Low risk of severe hypoglycaemia in patients with type 2 diabetes mellitus starting insulin therapy with premixed insulin analogues BID in outpatient settings

Dynamic risk factors associated with non‐severe hypoglycemia in patients treated with insulin glargine or exenatide once weekly 与每日一次使用甘精胰岛素或者每周一次使用艾塞那肽治疗的患者出现非严重低血糖相关的动态危险因素

HbA1c and hypoglycaemia in intensively treated type 2 diabetes: a retrospective cohort study in primary care

Contact Info

Product

Resources

About

Relationship between HbA1c and hypoglycaemia in patients with type 2 diabetes treated with different insulin regimens in combination with metformin

Cited by 15 publications

References 61 publications

Low risk of severe hypoglycaemia in patients with type 2 diabetes mellitus starting insulin therapy with premixed insulin analogues BID in outpatient settings

Low risk of severe hypoglycaemia in patients with type 2 diabetes mellitus starting insulin therapy with premixed insulin analogues BID in outpatient settings

Dynamic risk factors associated with non‐severe hypoglycemia in patients treated with insulin glargine or exenatide once weekly 与每日一次使用甘精胰岛素或者每周一次使用艾塞那肽治疗的患者出现非严重低血糖相关的动态危险因素

HbA1c and hypoglycaemia in intensively treated type 2 diabetes: a retrospective cohort study in primary care

Contact Info

Product

Resources

About

Relationship between HbA_1c and hypoglycaemia in patients with type 2 diabetes treated with different insulin regimens in combination with metformin