Lack of hypoglycemia awareness is common in insulin-treated T2D

  • van Meijel LA & al.
  • BMJ Open Diabetes Res Care
  • 1 Feb 2020

  • curated by Miriam Tucker
  • Clinical Essentials
Access to the full content of this site is available only to registered healthcare professionals. Access to the full content of this site is available only to registered healthcare professionals.

Takeaway

  • 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.

Study design

  • Observational study of 2350 insulin-treated people in Dutch diabetes centers.
  • Funding: Dutch Government, Dutch Federation of University Medical Centers.

Key results

  • 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).

Limitations

  • Possible overrepresentation of tertiary care centers.
  • IAH questionnaire not formally validated in T2D.
  • C-peptide not measured.