Risk of hypoglycaemia in types 1 and 2 diabetes: Effects of treatment modalities and their duration

S. R. Heller, P. Choudhary, C. Davies, C. Emery, M. J. Campbell, J. Freeman, S. A. Amiel, Rayaz Malik, B. M. Frier, K. V. Allen, N. N. Zammitt, K. MacLeod, K. F. Lonnen, D. Kerr, T. Richardson, S. Hunter, D. McLaughlin

Research output: Contribution to journalArticle

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Abstract

Aims/hypothesis: We explored the epidemiology of hypoglycaemia in individuals with insulin-treated diabetes by testing the hypothesis that diabetes type and duration of insulin treatment influence the risk of hypoglycaemia. Materials and methods: This was an observational study over 9-12 months in six UK secondary care diabetes centres. Altogether 383 patients were involved. Patients were divided into the following three treatment groups for type 2 diabetes: (1) sulfonylureas, (2) insulin for <2 years and (3) insulin for >5 years, and into two treatment groups for type 1 diabetes, namely <5 years disease duration and >15 years disease duration. Self-reported (mild and severe) and biochemical episodes (interstitial glucose <2.2 mmol/l using continuous glucose monitoring) were recorded. Results: Mild hypoglycaemia in type 2 diabetic patients on insulin for <2 years was less frequent than in type 1 patients with <5 years disease duration (mean rate: 4 vs 36 episodes per subject-year, p<0.001). In type 2 diabetic patients treated with sulfonylureas or insulin for <2 years, no differences were observed in the proportion experiencing severe hypoglycaemia (7 vs 7%, difference 0 [95% CI: -7 to 9%]), mild symptomatic (39 vs 51%, difference 12 [-3 to 25%]) or interstitial glucose <2.2 mol/l (22 vs 20%, difference 2 [-13 to 10%]). Severe hypoglycaemia rates were comparable in patients with type 2 diabetes on sulfonylureas or insulin < 2 years (0.1 and 0.2 episodes per subject-year) and far less frequent than in type 1 diabetes (<5 years group, 1.1; >15 years group, 3.2.episodes per subject-year). Conclusions/interpretation: During early insulin use in type 2 diabetes, the frequency of hypoglycaemia is generally equivalent to that observed in patients treated with sulfonylureas and considerably lower than during the first 5 years of treatment in type 1 diabetes.

Original languageEnglish
Pages (from-to)1140-1147
Number of pages8
JournalDiabetologia
Volume50
Issue number6
DOIs
Publication statusPublished - Jun 2007
Externally publishedYes

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Type 1 Diabetes Mellitus
Hypoglycemia
Type 2 Diabetes Mellitus
Insulin
Secondary Care Centers
Therapeutics
Observational Studies
Epidemiology
Glucose

Keywords

  • Continuous glucose monitoring
  • Epidemiology
  • Hypoglycaemia
  • Type 1 diabetes
  • Type 2 diabetes

ASJC Scopus subject areas

  • Internal Medicine
  • Endocrinology, Diabetes and Metabolism

Cite this

Heller, S. R., Choudhary, P., Davies, C., Emery, C., Campbell, M. J., Freeman, J., ... McLaughlin, D. (2007). Risk of hypoglycaemia in types 1 and 2 diabetes: Effects of treatment modalities and their duration. Diabetologia, 50(6), 1140-1147. https://doi.org/10.1007/s00125-007-0599-y

Risk of hypoglycaemia in types 1 and 2 diabetes : Effects of treatment modalities and their duration. / Heller, S. R.; Choudhary, P.; Davies, C.; Emery, C.; Campbell, M. J.; Freeman, J.; Amiel, S. A.; Malik, Rayaz; Frier, B. M.; Allen, K. V.; Zammitt, N. N.; MacLeod, K.; Lonnen, K. F.; Kerr, D.; Richardson, T.; Hunter, S.; McLaughlin, D.

In: Diabetologia, Vol. 50, No. 6, 06.2007, p. 1140-1147.

Research output: Contribution to journalArticle

Heller, SR, Choudhary, P, Davies, C, Emery, C, Campbell, MJ, Freeman, J, Amiel, SA, Malik, R, Frier, BM, Allen, KV, Zammitt, NN, MacLeod, K, Lonnen, KF, Kerr, D, Richardson, T, Hunter, S & McLaughlin, D 2007, 'Risk of hypoglycaemia in types 1 and 2 diabetes: Effects of treatment modalities and their duration', Diabetologia, vol. 50, no. 6, pp. 1140-1147. https://doi.org/10.1007/s00125-007-0599-y
Heller SR, Choudhary P, Davies C, Emery C, Campbell MJ, Freeman J et al. Risk of hypoglycaemia in types 1 and 2 diabetes: Effects of treatment modalities and their duration. Diabetologia. 2007 Jun;50(6):1140-1147. https://doi.org/10.1007/s00125-007-0599-y
Heller, S. R. ; Choudhary, P. ; Davies, C. ; Emery, C. ; Campbell, M. J. ; Freeman, J. ; Amiel, S. A. ; Malik, Rayaz ; Frier, B. M. ; Allen, K. V. ; Zammitt, N. N. ; MacLeod, K. ; Lonnen, K. F. ; Kerr, D. ; Richardson, T. ; Hunter, S. ; McLaughlin, D. / Risk of hypoglycaemia in types 1 and 2 diabetes : Effects of treatment modalities and their duration. In: Diabetologia. 2007 ; Vol. 50, No. 6. pp. 1140-1147.
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AU - Malik, Rayaz

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AU - Allen, K. V.

AU - Zammitt, N. N.

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N2 - Aims/hypothesis: We explored the epidemiology of hypoglycaemia in individuals with insulin-treated diabetes by testing the hypothesis that diabetes type and duration of insulin treatment influence the risk of hypoglycaemia. Materials and methods: This was an observational study over 9-12 months in six UK secondary care diabetes centres. Altogether 383 patients were involved. Patients were divided into the following three treatment groups for type 2 diabetes: (1) sulfonylureas, (2) insulin for <2 years and (3) insulin for >5 years, and into two treatment groups for type 1 diabetes, namely <5 years disease duration and >15 years disease duration. Self-reported (mild and severe) and biochemical episodes (interstitial glucose <2.2 mmol/l using continuous glucose monitoring) were recorded. Results: Mild hypoglycaemia in type 2 diabetic patients on insulin for <2 years was less frequent than in type 1 patients with <5 years disease duration (mean rate: 4 vs 36 episodes per subject-year, p<0.001). In type 2 diabetic patients treated with sulfonylureas or insulin for <2 years, no differences were observed in the proportion experiencing severe hypoglycaemia (7 vs 7%, difference 0 [95% CI: -7 to 9%]), mild symptomatic (39 vs 51%, difference 12 [-3 to 25%]) or interstitial glucose <2.2 mol/l (22 vs 20%, difference 2 [-13 to 10%]). Severe hypoglycaemia rates were comparable in patients with type 2 diabetes on sulfonylureas or insulin < 2 years (0.1 and 0.2 episodes per subject-year) and far less frequent than in type 1 diabetes (<5 years group, 1.1; >15 years group, 3.2.episodes per subject-year). Conclusions/interpretation: During early insulin use in type 2 diabetes, the frequency of hypoglycaemia is generally equivalent to that observed in patients treated with sulfonylureas and considerably lower than during the first 5 years of treatment in type 1 diabetes.

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KW - Epidemiology

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