High prevalence of impaired awareness of hypoglycemia and severe hypoglycemia among people with insulin-treated type 2 diabetes: The Dutch Diabetes Pearl Cohort
Van Meijel, Lian A.; De Vegt, Femmie; Abbink, Evertine J.; Rutters, Femke; Schram, Miranda T.; Van Der Klauw, Melanie M.; Wolffenbuttel, Bruce H.R.; Siegelaar, Sarah; Devries, J. Hans; Sijbrands, Eric J.G.; Özcan, Behiye; De Valk, Harold W.; Silvius, Bianca; Schaper, Nicolaas; Stehouwer, Coen D.A.; Elders, Petra J.M.; Tack, Cornelis J.; De Galan, Bastiaan E.
(2020) BMJ Open Diabetes Research and Care, volume 8, issue 1, pp. 1 - 8
(Article)
Abstract
Objective People with type 2 diabetes on insulin are at risk for hypoglycemia. Recurrent hypoglycemia can cause impaired awareness of hypoglycemia (IAH), and increase the risk for severe hypoglycemia. The aim of this study was to assess the prevalence and determinants of self-reported IAH and severe hypoglycemia in a Dutch
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nationwide cohort of people with insulin-treated type 2 diabetes. Research design and methods Observational study of The Dutch Diabetes Pearl, a cohort of people with type 2 diabetes treated in primary, secondary and tertiary diabetes care centers. The presence of IAH and the occurrence of severe hypoglycemia in the past year, defined as an event requiring external help to recover, were assessed using the validated Dutch version of the Clarke questionnaire. In addition, clinical variables were collected including age, diabetes duration, hemoglobin A1c, ethnicity and education. Results 2350 people with type 2 diabetes on insulin were included: 59.1% men, mean age 61.1±10.4 years, mean diabetes duration 14.8±9.2 years and 79.5% on basal-bolus therapy. A total of 229 patients (9.7%) were classified as having IAH and 742 patients (31.6%) reported severe hypoglycemia. Increased odds for IAH were found with complex insulin regimens and lower odds with having a partner and body mass index ≥30 kg/m 2. Severe hypoglycemia was associated with complex insulin regimens, non-Caucasian ethnicity and use of psychoactive drugs, and inversely with metformin use. Conclusions In this nationwide cohort, almost one out of ten people with type 2 diabetes on insulin had IAH and >30% had a history of severe hypoglycemia in the past year.
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Keywords: epidemiology, hypoglycemia, hypoglycemia unawareness, type 2 diabetes, Severity of Illness Index, Prevalence, Awareness, Humans, Middle Aged, Male, Treatment Outcome, Diabetes Mellitus, Type 2/drug therapy, Ethnic Groups, Hypoglycemia/chemically induced, Female, Surveys and Questionnaires, Aged, Glycated Hemoglobin A/analysis, Hypoglycemic Agents/adverse effects, Netherlands/epidemiology, Cohort Studies, Insulin/adverse effects, Endocrinology, Diabetes and Metabolism, Research Support, Non-U.S. Gov't, Observational Study, Journal Article
Publisher: BMJ Publishing Group
Note: Funding Information: Competing interests FR has received grants from the Dutch government, during the conduct of the study. JHD has received personal fees from Novo Nordisk and Sanofi, outside the submitted work. CJT has received grants from AstraZeneca, personal fees and other from NovoNordisk and from Merck, outside the submitted work. BEDG has received grants from the Dutch Federation of University Medical Centers, during the conduct of the study and personal fees from NovoNordisk, outside the submitted work. Publisher Copyright: © Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.
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