- Impaired awareness of hypoglycemia (IAH) and severe hypoglycemia are relatively common among insulin-treated people with type 2 diabetes (T2D).
Why this matters
- IAH and severe hypoglycemia are well-described in type 1 diabetes but not in insulin-treated T2D.
- Observational study of 2350 insulin-treated people in Dutch diabetes centers.
- Funding: Dutch Government, Dutch Federation of University Medical Centers.
- IAH (≥3 points on validated Dutch version of Clarke questionnaire) present in 229 individuals (9.7%), with no differences by sex or primary vs secondary/tertiary care.
- No difference in glycemic control, but IAH was significantly greater among individuals with HbA1c
- After multivariate adjustment, IAH risk was:
- Higher with complex insulin regimens: OR, 1.75 (95% CI, 1.06-2.88) but
- Lower with:
- Having a partner: 0.59 (0.42-0.84); and
- BMI 2: 0.71 (0.51-0.98).
- Severe hypoglycemia (requiring assistance to recover) in the past year occurred in 742 patients (31.6%), 193 (8.2%) of whom required medical intervention.
- After adjustments, severe hypoglycemia risk was lower with white identity (0.69; 0.54-0.88) and metformin use (0.76; 0.62-0.93) and higher with complex insulin regimens (1.44; 1.07-1.94) and psychoactive drug use (1.37; 1.08-1.75).
- Possible overrepresentation of tertiary care centers.
- IAH questionnaire not formally validated in T2D.
- C-peptide not measured.