Risk of hypoglycaemia in types 1 and 2 diabetes: effects of treatment modalities and their duration

Abstract

Aims/hypothesis We explored the epidemiology of hypoglycaemia in individuals with insulin-treated diabetes by testing the hypothesis that diabetes type and duration of insulin treatment influence the risk of hypoglycaemia. Materials and methods This was an observational study over 9-12 months in six UK secondary care diabetes centres. Altogether 383 patients were involved. Patients were divided into the following three treatment groups for type 2 diabetes: (1) sulfonylureas, (2) insulin for <2 years and (3) insulin for >5 years, and into two treatment groups for type 1 diabetes, namely <5 years disease duration and >15 years disease duration. Self-reported (mild and severe) and biochemical episodes (interstitial glucose <2.2 mmol/l using continuous glucose monitoring) were recorded. Results Mild hypoglycaemia in type 2 diabetic patients on insulin for <2 years was less frequent than in type 1 patients with <5 years disease duration (mean rate: 4 vs 36 episodes per subject-year, p<0.001). In type 2 diabetic patients treated with sulfonylureas or insulin for <2 years, no differences were observed in the proportion experiencing severe hypoglycaemia (7 vs 7%, difference 0 [95% CI: −7to 9%]), mild symptomatic (39 vs 51%, difference 12 [−3 to 25%]) or interstitial glucose <2.2 mol/l (22 vs 20%, difference 2 [−13 to 10%]). Severe hypoglycaemia rates were comparable in patients with type 2 diabetes on sulfonylureas or insulin < 2 years (0.1 and 0.2 episodes per subject-year) and far less frequent than in type 1 diabetes (<5 years group, 1.1; >15 years group, 3.2. episodes per subject-year). Conclusions/interpretation During early insulin use in type 2 diabetes, the frequency of hypoglycaemia is generally equivalent to that observed in patients treated with sulfonylureas and considerably lower than during the first 5 years of treatment in type 1 diabetes.

Incidence and care‐related costs of severe hypoglycaemia requiring emergency treatment in Andalusia (Spain): the PAUEPAD project

“…Event rates for severe hypoglycaemia in people with Type 1 diabetes range from 115 to 320 per 100 person‐years 6, 7, 8, 9. Severe hypoglycaemia in insulin‐treated individuals with Type 2 diabetes has been shown to occur at rates of 10–70 episodes per 100 person‐years 6, 7, 8, 9. However, when broader populations of people with Type 2 diabetes are included, the incidence of severe hypoglycaemia ranges from 0 to 3 per 100 person‐years in adults with Type 2 diabetes 7.…”

Approach to assessing the economic impact of insulin‐related hypoglycaemia using the novel Local Impact of Hypoglycaemia Tool

“…The Medline, EMBASE, NHS EED and EconLIT databases were searched, and publications were limited to those in the English language and to population‐based, observational, non‐randomised controlled trials conducted in the UK. The search highlighted the lack of data on hypoglycaemia rates and resource use for the treatment of severe and non‐severe episodes; however, the key studies identified in the review were the UK Hypoglycaemia Study Group 2007 study 5 (for rates of severe and non‐severe hypoglycaemia) and Hammer et al . 10, Leese et al .…”

“…Rates of hypoglycaemia for the model were obtained from the UK Hypoglycaemia Study Group study 5, which was identified by the literature review as having the most complete and comprehensive data on severe and non‐severe hypoglycaemia rates in people with Type 1 diabetes and Type 2 diabetes.…”

“…It is defined as severe when assistance from another individual is required, and non‐severe when it can be self‐treated 4. People in the UK with Type 1 diabetes mellitus treated with insulin for > 15 years are reported to experience, on average, 3.2 severe and 29.0 non‐severe hypoglycaemic episodes per year, whereas the rate is 0.7 severe and 10.2 non‐severe per year for people with Type 2 diabetes mellitus treated with insulin for > 5 years 5.…”

Diabetes management and daily functioning burden of non‐severe hypoglycemia in Japanese people treated with insulin

“…Estimates for the incidence of NSHE range between 31.2 and 83.2 episodes per year in type 1 diabetes, and 4.16 and 15.6 episodes per year for insulin‐treated type 2 diabetes2, 3, 4.…”