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Hypoglycaemia in Type 2 diabetes.

Amiel SA, Dixon T, Mann R, Jameson K - Diabet. Med. (2008)

Bottom Line: SUs are associated with significantly lower rates of severe hypoglycaemia.However, large numbers of patients take SUs in the UK, and it is estimated that each year > 5000 patients will experience a severe event caused by their SU therapy which will require emergency intervention.Their use, and more prudent use of older therapies with low risk of hypoglycaemia, may help patients achieve improved glucose control for longer, and reduce the risk of diabetic complications.

View Article: PubMed Central - PubMed

Affiliation: King's College London School of Medicine, London, UK.

ABSTRACT
The primary cause of hypoglycaemia in Type 2 diabetes is diabetes medication-in particular, those which raise insulin levels independently of blood glucose, such as sulphonylureas (SUs) and exogenous insulin. The risk of hypoglycaemia is increased in older patients, those with longer diabetes duration, lesser insulin reserve and perhaps in the drive for strict glycaemic control. Differing definitions, data collection methods, drug type/regimen and patient populations make comparing rates of hypoglycaemia difficult. It is clear that patients taking insulin have the highest rates of self-reported severe hypoglycaemia (25% in patients who have been taking insulin for > 5 years). SUs are associated with significantly lower rates of severe hypoglycaemia. However, large numbers of patients take SUs in the UK, and it is estimated that each year > 5000 patients will experience a severe event caused by their SU therapy which will require emergency intervention. Hypoglycaemia has substantial clinical impact, in terms of mortality, morbidity and quality of life. The cost implications of severe episodes-both direct hospital costs and indirect costs-are considerable: it is estimated that each hospital admission for severe hypoglycaemia costs around pound1000. Hypoglycaemia and fear of hypoglycaemia limit the ability of current diabetes medications to achieve and maintain optimal levels of glycaemic control. Newer therapies, which focus on the incretin axis, may carry a lower risk of hypoglycaemia. Their use, and more prudent use of older therapies with low risk of hypoglycaemia, may help patients achieve improved glucose control for longer, and reduce the risk of diabetic complications.

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Related in: MedlinePlus

Proportion of patients with Type 2 and Type 1 diabetes of differing durations and receiving different regimens experiencing at least one severe hypoglycaemic attack during 9–12 months’ follow-up. All patients were receiving insulin except the group treated with sulphonylurea [35]. Reproduced from [35] with kind permission of Springer Science and Business Media.
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fig02: Proportion of patients with Type 2 and Type 1 diabetes of differing durations and receiving different regimens experiencing at least one severe hypoglycaemic attack during 9–12 months’ follow-up. All patients were receiving insulin except the group treated with sulphonylurea [35]. Reproduced from [35] with kind permission of Springer Science and Business Media.

Mentions: One possible contributor to the difference in observed rate of severe hypoglycaemia between the patient populations of the UKPDS and DARTS-MEMO studies is duration of diabetes—patients were newly diagnosed at entry to UKPDS [21]. It is important also to look at the duration of insulin therapy when considering hypoglycaemia rates in patients with Type 2 diabetes treated with insulin. The Department for Transport study outlined above [35] found that 51% of patients taking insulin for < 2 years had experienced at least one hypoglycaemic episode during the 9–12 months of follow-up, compared with 64% of patients taking insulin for > 5 years. Rates of hypoglycaemia recorded by continuous glucose monitoring (defined as values of < 2.2 mmol/l for at least 20 min) were 20% and 22%, respectively. However, corresponding figures for severe hypoglycaemia were 7% and 25%. In comparison, the rate of severe hypoglycaemia in insulin-treated Type 1 patients of < 5 years’ duration was 22%, rising to 46% in patients with long duration (> 15 years) (Fig. 2).


Hypoglycaemia in Type 2 diabetes.

Amiel SA, Dixon T, Mann R, Jameson K - Diabet. Med. (2008)

Proportion of patients with Type 2 and Type 1 diabetes of differing durations and receiving different regimens experiencing at least one severe hypoglycaemic attack during 9–12 months’ follow-up. All patients were receiving insulin except the group treated with sulphonylurea [35]. Reproduced from [35] with kind permission of Springer Science and Business Media.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC2327221&req=5

fig02: Proportion of patients with Type 2 and Type 1 diabetes of differing durations and receiving different regimens experiencing at least one severe hypoglycaemic attack during 9–12 months’ follow-up. All patients were receiving insulin except the group treated with sulphonylurea [35]. Reproduced from [35] with kind permission of Springer Science and Business Media.
Mentions: One possible contributor to the difference in observed rate of severe hypoglycaemia between the patient populations of the UKPDS and DARTS-MEMO studies is duration of diabetes—patients were newly diagnosed at entry to UKPDS [21]. It is important also to look at the duration of insulin therapy when considering hypoglycaemia rates in patients with Type 2 diabetes treated with insulin. The Department for Transport study outlined above [35] found that 51% of patients taking insulin for < 2 years had experienced at least one hypoglycaemic episode during the 9–12 months of follow-up, compared with 64% of patients taking insulin for > 5 years. Rates of hypoglycaemia recorded by continuous glucose monitoring (defined as values of < 2.2 mmol/l for at least 20 min) were 20% and 22%, respectively. However, corresponding figures for severe hypoglycaemia were 7% and 25%. In comparison, the rate of severe hypoglycaemia in insulin-treated Type 1 patients of < 5 years’ duration was 22%, rising to 46% in patients with long duration (> 15 years) (Fig. 2).

Bottom Line: SUs are associated with significantly lower rates of severe hypoglycaemia.However, large numbers of patients take SUs in the UK, and it is estimated that each year > 5000 patients will experience a severe event caused by their SU therapy which will require emergency intervention.Their use, and more prudent use of older therapies with low risk of hypoglycaemia, may help patients achieve improved glucose control for longer, and reduce the risk of diabetic complications.

View Article: PubMed Central - PubMed

Affiliation: King's College London School of Medicine, London, UK.

ABSTRACT
The primary cause of hypoglycaemia in Type 2 diabetes is diabetes medication-in particular, those which raise insulin levels independently of blood glucose, such as sulphonylureas (SUs) and exogenous insulin. The risk of hypoglycaemia is increased in older patients, those with longer diabetes duration, lesser insulin reserve and perhaps in the drive for strict glycaemic control. Differing definitions, data collection methods, drug type/regimen and patient populations make comparing rates of hypoglycaemia difficult. It is clear that patients taking insulin have the highest rates of self-reported severe hypoglycaemia (25% in patients who have been taking insulin for > 5 years). SUs are associated with significantly lower rates of severe hypoglycaemia. However, large numbers of patients take SUs in the UK, and it is estimated that each year > 5000 patients will experience a severe event caused by their SU therapy which will require emergency intervention. Hypoglycaemia has substantial clinical impact, in terms of mortality, morbidity and quality of life. The cost implications of severe episodes-both direct hospital costs and indirect costs-are considerable: it is estimated that each hospital admission for severe hypoglycaemia costs around pound1000. Hypoglycaemia and fear of hypoglycaemia limit the ability of current diabetes medications to achieve and maintain optimal levels of glycaemic control. Newer therapies, which focus on the incretin axis, may carry a lower risk of hypoglycaemia. Their use, and more prudent use of older therapies with low risk of hypoglycaemia, may help patients achieve improved glucose control for longer, and reduce the risk of diabetic complications.

Show MeSH
Related in: MedlinePlus