Type 2 diabetes: incidence and severity of hypoglycaemia by treatment regimen

  • Dunkley AJ & al.
  • Diabetes Obes Metab
  • 6 Mar 2019

  • curated by Sarfaroj Khan
  • UK Clinical Digest
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

  • Hypoglycaemia episodes continue to represent a substantial burden for people with type 2 diabetes mellitus (T2DM) treated in primary care.
  • Treatment with sulfonylureas and insulin are both associated with a risk of reported non-severe hypoglycaemia; however, the incidence of severe hypoglycaemia is lower with sulfonylureas.

Why this matters

  • Finding adds support to the continued importance of sulfonylureas use as a possible therapy of choice in appropriate patients with T2DM.

Study design

  • This prospective study was conducted in the UK primary care setting between 2012 and 2016 and recruited participants via volunteer general practices based on treatment regimen (n=325).
  • Participants prospectively self-recorded data on blood glucose in a monthly diary and hypoglycaemic episodes using a study-specific form during a 12-month period.
  • Funding: Primary Care Diabetes Society.

Key results

  • Overall 39.2% of participants experienced ≥1 hypoglycaemia episode (92% experienced ≥1 non-severe episode, 17% ≥1 severe and 53% ≥1 nocturnal episode).
  • Hypogylcaemia incidence ranged from 4.39 for insulin, 2.34 sulfonylurea, 0.76 metformin and 0.56 incretin-based.
  • Risk for non-severe hypoglycaemia was significantly higher for both sulfonylurea (incidence rate ratio [IRR], 3.09; 95% CI, 1.83-5.21; P<.001 and insulin ci p compared with metformin.>
  • Risk for nocturnal episodes was substantially higher for both sulfonylurea (IRR, 2.67; 95% CI, 1.13-6.28; P=.025) and insulin vs metformin (IRR, 7.48; 95% CI, 3.29-17.0; P<.001>
  • For severe episodes, the incidence was similar for metformin, incretin-based and sulfonylurea (0.07, 0.07 and 0.09, respectively)
  • Risk for severe episode was significantly higher with insulin vs metformin (incidence rate, 0.32; IRR, 4.55; 95% CI, 1.28-16.20; P=.019).

Limitations

  • Sodium-glucose co-transporter 2 inhibitors not included as they were not licenced for use in the United Kingdom until after the study had commenced.
  • Selection bias.

Please confirm your acceptance

To gain full access to GPnotebook please confirm:

By submitting here you confirm that you have accepted Terms of Use and Privacy Policy of GPnotebook.

Submit