TY - JOUR
T1 - High prevalence of impaired awareness of hypoglycemia and severe hypoglycemia among people with insulin-treated type 2 diabetes
T2 - The Dutch Diabetes Pearl Cohort
AU - Van Meijel, Lian A.
AU - De Vegt, Femmie
AU - Abbink, Evertine J.
AU - Rutters, Femke
AU - Schram, Miranda T.
AU - Van Der Klauw, Melanie M.
AU - Wolffenbuttel, Bruce H.R.
AU - Siegelaar, Sarah
AU - Devries, J. Hans
AU - Sijbrands, Eric J.G.
AU - Özcan, Behiye
AU - De Valk, Harold W.
AU - Silvius, Bianca
AU - Schaper, Nicolaas
AU - Stehouwer, Coen D.A.
AU - Elders, Petra J.M.
AU - Tack, Cornelis J.
AU - De Galan, Bastiaan E.
N1 - 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.
PY - 2020/2/26
Y1 - 2020/2/26
N2 - 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 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.
AB - 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 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.
KW - epidemiology
KW - hypoglycemia
KW - hypoglycemia unawareness
KW - type 2 diabetes
KW - Severity of Illness Index
KW - Prevalence
KW - Awareness
KW - Humans
KW - Middle Aged
KW - Male
KW - Treatment Outcome
KW - Diabetes Mellitus, Type 2/drug therapy
KW - Ethnic Groups
KW - Hypoglycemia/chemically induced
KW - Female
KW - Surveys and Questionnaires
KW - Aged
KW - Glycated Hemoglobin A/analysis
KW - Hypoglycemic Agents/adverse effects
KW - Netherlands/epidemiology
KW - Cohort Studies
KW - Insulin/adverse effects
UR - http://www.scopus.com/inward/record.url?scp=85081215695&partnerID=8YFLogxK
U2 - 10.1136/bmjdrc-2019-000935
DO - 10.1136/bmjdrc-2019-000935
M3 - Article
C2 - 32107264
AN - SCOPUS:85081215695
VL - 8
SP - 1
EP - 8
JO - BMJ Open Diabetes Research and Care
JF - BMJ Open Diabetes Research and Care
IS - 1
M1 - e000935
ER -