<abstract xmlns="http://www.w3.org/1999/xhtml"><sec id="j_sjph-2017-0033_s_009_w2aab3b7b8b1b6b1aab1c18b1Aa"><h3>Introduction</h3><p>Hypoglycaemia is the major barrier for glycaemic target achievement in patients treated with insulin. The aim of the present study was to investigate real-world incidence and predictors of hypoglycaemia in insulin-treated patients.</p></sec><sec id="j_sjph-2017-0033_s_010_w2aab3b7b8b1b6b1aab1c18b2Aa"><h3>Methods</h3><p>More than 300 consecutive patients with type 1 or type 2 diabetes treated with insulin were enrolled during regular out-patient visits from 36 diabetes practices throughout the whole country. They completed a comprehensive questionnaire on hypoglycaemia knowledge, awareness, and incidence in the last month and last six months. In addition, in the prospective part, patients recorded incidence of hypoglycaemic events using a special diary prospectively on a daily basis, through 4 weeks.</p></sec><sec id="j_sjph-2017-0033_s_011_w2aab3b7b8b1b6b1aab1c18b3Aa"><h3>Results</h3><p>At least one hypoglycaemic event was self-reported in 84.1%, and 56.4% of patients with type 1 and type 2 diabetes, respectively, during the prospective period of 4 weeks. 43.4% and 26.2% of patients with type 1 and type 2 diabetes, respectively, experienced a nocturnal hypoglycaemic event. In the same time-period, severe hypoglycaemia was experienced by 15.9% and 7.1% of patients with type 1 and type 2 diabetes, respectively. Lower glycated haemoglobin was not a significant predictor of hypoglycaemia.</p></sec><sec id="j_sjph-2017-0033_s_012_w2aab3b7b8b1b6b1aab1c18b4Aa"><h3>Conclusions</h3><p>Rates of self-reported hypoglycaemia in patients treated with insulin in the largest and most comprehensive study in Slovenia so far are higher than reported from randomised control trials, but comparable to data from observational studies. Hypoglycaemia incidence was high even with high glycated haemoglobin values.</p></sec></abstract>

IntroductionHypoglycaemia is the major barrier for glycaemic target achievement in patients treated with insulin. The aim of the present study was to investigate real-world incidence and predictors of hypoglycaemia in insulin-treated patients.MethodsMore than 300 consecutive patients with type 1 or type 2 diabetes treated with insulin were enrolled during regular out-patient visits from 36 diabetes practices throughout the whole country. They completed a comprehensive questionnaire on hypoglycaemia knowledge, awareness, and incidence in the last month and last six months. In addition, in the prospective part, patients recorded incidence of hypoglycaemic events using a special diary prospectively on a daily basis, through 4 weeks.ResultsAt least one hypoglycaemic event was self-reported in 84.1%, and 56.4% of patients with type 1 and type 2 diabetes, respectively, during the prospective period of 4 weeks. 43.4% and 26.2% of patients with type 1 and type 2 diabetes, respectively, experienced a nocturnal hypoglycaemic event. In the same time-period, severe hypoglycaemia was experienced by 15.9% and 7.1% of patients with type 1 and type 2 diabetes, respectively. Lower glycated haemoglobin was not a significant predictor of hypoglycaemia.ConclusionsRates of self-reported hypoglycaemia in patients treated with insulin in the largest and most comprehensive study in Slovenia so far are higher than reported from randomised control trials, but comparable to data from observational studies. Hypoglycaemia incidence was high even with high glycated haemoglobin values.

Self-reported hypoglycaemia in patients treated with insulin: A large Slovenian retrospectively-prospective study

Slovenian Journal of Public Health

This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 License.

HIPOGLIKEMIJE PRI BOLNIKIH, ZDRAVLJENIH Z INSULINOM: VELIKA SLOVENSKA RETROSPEKTIVNOPROSPEKTIVNA RAZISKAVA

IntroductionHypoglycaemia is the major barrier for glycaemic target achievement in patients treated with insulin. The aim of the present study was to...

VARIABLES	HR	95% C.I.	P-VALUE
Age (years)	0.99	0.96, 1.02	0.556
Female gender	0.80	0.36, 1.78	0.585
HbA1c (%)	1.01	0.98, 1.04	0.441
Diabetes duration (years)	1.02	0.94, 1.11	0.594
Type of insulin therapy
Short-acting (reference)	-	-	-
Long-acting	0.54	0.10, 3.07	0.489
Long and short-acting	0.70	0.21, 2.28	0.550
Mixed	NC	NC	NC
Other	0.36	0.08, 1.57	0.175
Blood glucose testing (per day)	1.08	0.84, 1.38	0.555
Hypoglycaemia unawareness	1.00	0.44, 2.24	0.996
Fear of hypoglycaemia	1.20	1.05, 1.37	0.009
Diabetes type 2	0.72	0.20, 2.67	0.627

	DM type 1	DM type 2
	N=84	N=227
Age (years)	49±13	64±10
Gender (male/female, %)	57/43	62/38
Diabetes duration (years)	21±11	16±9
Insulin therapy duration (years)	19±12	6 (3, 10) Non-normally distributed variables are represented as median (25th, 75th percentile)
HbA1c (%)	9.2±2.7	9.3±2.8
Employed/unemployed/retired/other (%)	65/5/28/12	15/8/75/2
Diabetes treatment
Short-acting insulin	85.7	48.9
Long-acting insulin	60.7	63.1
Pre-mixed insulin	1.2	35.1
Oral therapy	4.8	24.9
Injectable non-insulin therapy	3.6	10.2
Insulin pump	32.1	4.9
Self-measurement of blood glucose (%)	98.8	99.6
Continuous glucose measurement (%)	34.2	38.4
Hypoglycaemia experience (%)	98.8	89.2

Self-reported hypoglycaemia in patients treated with insulin: A large Slovenian retrospectively-prospective study

Article Category: Original scientific article

Published Online: Oct 09, 2017

Page range: 244 - 250

Received: Feb 14, 2017

Accepted: Aug 10, 2017

DOI: https://doi.org/10.1515/sjph-2017-0033

Keywords
hypoglycaemia, type 1 diabetes, type 2 diabetes, insulin treatment, Slovenia

© 2017 National Institute of Public Health, Slovenia

This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 License.

Figure 1

Figure 2

Figure 3

Predictors of severe hypoglycaemia in a fully adjusted negative binomial model.

Baseline characteristics of patients included.

Self-reported hypoglycaemia in patients treated with insulin: A large Slovenian retrospectively-prospective study

Article Category: Original scientific article

Published Online: Oct 09, 2017

Page range: 244 - 250

Received: Feb 14, 2017

Accepted: Aug 10, 2017

DOI: https://doi.org/10.1515/sjph-2017-0033

Keywordshypoglycaemia, type 1 diabetes, type 2 diabetes, insulin treatment, Slovenia

© 2017 National Institute of Public Health, Slovenia

This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 License.

Figure 1

Figure 2

Figure 3

Predictors of severe hypoglycaemia in a fully adjusted negative binomial model.

Baseline characteristics of patients included.

Keywords
hypoglycaemia, type 1 diabetes, type 2 diabetes, insulin treatment, Slovenia