SelfTreated Hypoglycemia in Type 2 Diabetes Melli

Authors: Meryl Brod Gagik Galstyan Ambika Gopalakrishnan Unnikrishnan Ilana HarmanBoehm Vinay Prusty Fernando Lavalle Margaret McGill Angela Murphy Felix Puchulu

Publish Date: 2016/03/21

Volume: 7, Issue: 2, Pages: 279-293

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Abstract

The aim of this study was to assess the total frequency of selftreated hypoglycemia in type 2 diabetes mellitus patients using regimens including basal insulin analogs and to describe the psychological impact and behavioral response to these events from the perspective of patients and prescribers ie hospital specialists and primary care physiciansThe global attitude of patients and physicians 2 GAPP2 survey was an online multinational crosssectional survey of patients with type 2 diabetes mellitus treated with basal insulin analogs with or without bolus insulin Prescribers directly involved in the care of these patients were also surveyed Here we report the results of the second wave of the GAPP2 survey in which the primary variable of interest was selftreated hypoglycemiaA total of 855 patients and 1003 prescribers from 7 countries completed the survey Overall 28 of patients had experienced selftreated hypoglycemia during the previous 30 days with twothirds of events occurring during the day and onethird of events occurring nocturnally Prescribers reported discussing events with 55 of patients over this period Patients worried about selftreated hypoglycemia in a range of situations and prescribers underestimated this worry Many patients who had experienced selftreated hypoglycemia in the last 30 days reported missing 19 mistiming 7 or reducing 7 their basal insulin dose as a resultSelftreated hypoglycemia was relatively common in patients using basal insulin analogs with or without bolus insulin Whilst the frequency of hypoglycemia was greater during the daytime than at night patients worried more about nocturnal events and this level of worry was underestimated by physicians Additional advice and support may be needed for both patients and prescribers to reduce the frequency and impact of selftreated hypoglycemiaThe use of insulin to reduce blood glucose levels in type 2 diabetes mellitus T2DM is highly effective but can be challenging eg taking time to develop an appropriate regimen and the risk of hypoglycemia remains an important consideration for both physicians and patients 1 2 3Severe hypoglycemia defined as an event requiring the assistance of another person to actively administer carbohydrates glucagon or take other corrective actions is a key cause of morbidity in T2DM and an important barrier to optimal glycemic control 4 Less severe hypoglycemic events that the individual can selftreat by consuming fastacting carbohydrate known as ‘selftreated’ or ‘minor’ hypoglycemic events are not always recognized by the individual or their clinical team as being clinically significant Data suggest that selftreated hypoglycemic events whether they occur in the daytime or at night have an impact on patient functioning wellbeing and diabetes management 5 6 7 Of particular importance is the relationship between often unnoticed nocturnal hypoglycemia and poor health outcomes including adverse cardiovascular events 8 Selftreated hypoglycemia also has substantial economic consequences for patients and their employers due to lost working hours and reduced productivity 7 Recently reported data from Denmark suggest that 9 of selftreated episodes lead to lost work time 9 In the UK selftreated hypoglycemia is estimated to cost the National Health Service £1721 million per year 10 Recent research in the USA found that nonsevere episodes incur a cost of 11 per episode 11

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