Subscribe to RSS
DOI: 10.1055/a-1310-7963
Conversations and Reactions Around Severe Hypoglycaemia (CRASH): Results from the German Cohort of a Global Survey of People with Type 1 Diabetes or Insulin-Treated Type 2 Diabetes and Caregivers
Funding: This work was supported by Eli Lilly and Company. Eli Lilly and Company were also involved in the collection, analysis, and interpretation of the data, the writing of the report, and the decision to submit the article for publication.Abstract
Background A global cross-sectional survey (CRASH) was designed to provide information about the experiences of people with diabetes (PWD) and their caregivers in relation to severe hypoglycaemic events.
Methods Adults with type 1 diabetes or insulin-treated type 2 diabetes who had experienced one or more severe hypoglycaemic events within the past 3 years, and adult caregivers for such people, were recruited from medical research panels using purposive sampling. We present here results from Germany.
Results Approximately 100 individuals in each of the four participant groups completed a 30-minute online survey. Survey results indicated that the most recent severe hypoglycaemic event made many participants feel scared (80.4%), unprepared (70.4%), and/or helpless (66.5%). Severe hypoglycaemia was discussed by healthcare professionals at every visit with only 20.2% of participants who had ever had this conversation, and 53.5% of participants indicated that their insulin regimen had not changed following their most recent event. 37.1% of PWD/people with diabetes cared for by caregivers owned a glucagon kit at the time of survey completion.
Conclusions The survey identified areas for improvement in the prevention and management of severe hypoglycaemic events. For healthcare professionals, these include enquiring more frequently about severe hypoglycaemia and adjusting blood glucose-lowering medication after a severe hypoglycaemic event. For individuals with diabetes and their caregivers, potential improvements include ensuring availability of glucagon at all times. Changes in these areas could lead not only to improved patient wellbeing but also to reduced use of emergency services/hospitalisation and, consequently, lower healthcare costs.
Publication History
Received: 09 June 2020
Received: 03 November 2020
Accepted: 10 November 2020
Article published online:
23 December 2020
© 2020. Thieme. All rights reserved.
Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany
-
References
- 1 Silbert R, Salcido-Montenegro A, Rodriguez-Gutierrez R. et al. Hypoglycemia among patients with type 2 diabetes: Epidemiology, risk factors, and prevention strategies. Curr Diab Rep 2018; 18: 53
- 2 Little SA, Leelarathna L, Barendse SM. et al. Severe hypoglycaemia in type 1 diabetes mellitus: Underlying drivers and potential strategies for successful prevention. Diabetes Metab Res Rev 2014; 30: 175-190
- 3 ORIGIN Trial Investigators Predictors of nonsevere and severe hypoglycemia during glucose-lowering treatment with insulin glargine or standard drugs in the ORIGIN trial. Diabetes Care 2015; 38: 22-28
- 4 Kern W, Holstein A, Moenninghoff C. et al. Self-reported hypoglycaemic events in 2430 patients with insulin-treated diabetes in the German sub-population of the HAT study. Exp Clin Endocrinol Diabetes 2017; 125: 592-597
- 5 Cariou B, Fontaine P, Eschwege E. et al. Frequency and predictors of confirmed hypoglycaemia in type 1 and insulin-treated type 2 diabetes mellitus patients in a real-life setting: results from the DIALOG study. Diabetes Metab 2015; 41: 116-125
- 6 Khunti K, Alsifri S, Aronson R. et al. Impact of hypoglycaemia on patient-reported outcomes from a global, 24-country study of 27,585 people with type 1 and insulin-treated type 2 diabetes. Diabetes Res Clin Pract 2017; 130: 121-129
- 7 Inkster B, Frier BM. Diabetes and driving. Diabetes Obes Metab 2013; 15: 775-783
- 8 Marchesini G, Veronese G, Forlani G. et al. The management of severe hypoglycemia by the emergency system: The HYPOTHESIS study. Nutr Metab Cardiovasc Dis 2014; 24: 1181-1188
- 9 Hung YC, Lin CC, Chen HJ. et al. Severe hypoglycemia and hip fracture in patients with type 2 diabetes: a nationwide population-based cohort study. Osteoporos Int 2017; 28: 2053-2060
- 10 Malabu UH, Vangaveti VN, Kennedy RL. Disease burden evaluation of fall-related events in the elderly due to hypoglycemia and other diabetic complications: A clinical review. Clin Epidemiol 2014; 6: 287-294
- 11 Frier BM. Hypoglycaemia in diabetes mellitus: Epidemiology and clinical implications. Nat Rev Endocrinol 2014; 10: 711-722
- 12 Pieber TR, Marso SP, McGuire DK. et al. DEVOTE 3: Temporal relationships between severe hypoglycaemia, cardiovascular outcomes and mortality. Diabetologia 2018; 61: 58-65
- 13 Davis SN, Duckworth W, Emanuele N. et al. Effects of severe hypoglycemia on cardiovascular outcomes and death in the Veterans Affairs Diabetes Trial. Diabetes Care 2019; 42: 157-163
- 14 Hendrieckx C, Ivory N, Singh H. et al. Impact of severe hypoglycaemia on psychological outcomes in adults with type 2 diabetes: A systematic review. Diabet Med 2019; 36: 1082-1091
- 15 Languren G, Montiel T, Ramírez-Lugo L. et al. Recurrent moderate hypoglycemia exacerbates oxidative damage and neuronal death leading to cognitive dysfunction after the hypoglycemic coma. J Cereb Blood Flow Metab 2019; 39: 808-821
- 16 Gold AE, MacLeod KM, Frier BM. Frequency of severe hypoglycemia in patients with type 1 diabetes and impaired awareness of hypoglycemia. Diabetes Care 1994; 17: 697-703
- 17 Conget I, Ávila D, Giménez M. et al. Impaired awareness of hypoglycaemia in subjects with type 1 diabetes. Results of an online survey in a diabetes web site. Endocrinol Nutr 2016; 63: 121-125
- 18 Graveling AJ, Frier BM. Impaired awareness of hypoglycaemia: a review. Diabetes Metab 2010; 36: S64-S74
- 19 Holstein A, Plaschke A, Egberts EH. Clinical characterisation of severe hypoglycaemia: A prospective population-based study. Exp Clin Endocrinol Diabetes 2003; 111: 364-369
- 20 Schopman JE, Geddes J, Frier BM. Prevalence of impaired awareness of hypoglycaemia and frequency of hypoglycaemia in insulin-treated type 2 diabetes. Diabetes Res Clin Pract 2010; 87: 64-68
- 21 Alkhatatbeh MJ, Abdalqader NA, Alqudah MAY. Impaired awareness of hypoglycaemia in insulin-treated type 2 diabetes mellitus. Curr Diabetes Rev 2019; 15: 407-413
- 22 Zhu L, Ang LC, Tan WB. et al. A study to evaluate the prevalence of impaired awareness of hypoglycaemia in adults with type 2 diabetes in outpatient clinic in a tertiary care centre in Singapore. Ther Adv Endocrinol Metab 2017; 8: 69-74
- 23 Hopkins D, Lawrence I, Mansell P. et al. Improved biomedical and psychological outcomes 1 year after structured education in flexible insulin therapy for people with type 1 diabetes: the U.K. DAFNE experience. Diabetes Care 2012; 35: 1638-1642
- 24 Geddes J, Schopman JE, Zammitt NN. et al. Prevalence of impaired awareness of hypoglycaemia in adults with type 1 diabetes. Diabet Med 2008; 25: 501-504
- 25 Deutsche Diabetes Gesellschaft. S3-Leitlinie Therapie des Typ-1-Diabetes; 2.Auflage; 2018. Available at https: //www.awmf.org/uploads/tx_szleitlinien/057-013l_S3-Therapie-Typ-1-Diabetes_2018-08.pdf Accessed February 01, 2020
- 26 Landgraf R, Aberle J. et al. Therapie des Typ-2-Diabetes. Diabetologie 2019; 14: S167-S187
- 27 American Diabetes Association Standards of medical care in diabetes – 2020. Diabetes Care 2020; 43: S1-S212
- 28 Brož J, Brabec M, Janíčková Žďárská D. et al. Fear of driving license withdrawal in patients with insulin-treated diabetes mellitus negatively influences their decision to report severe hypoglycemic events to physicians. Patient Prefer Adherence 2015; 9: 1367-1370
- 29 Dømgaard M, Bagger M, Rhee NA. et al. Individual and societal consequences of hypoglycemia: A cross-sectional survey. Postgrad Med 2015; 127: 438-445
- 30 Pedersen-Bjergaard U, Færch L, Allingbjerg ML. et al. The influence of new European Union driver's license legislation on reporting of severe hypoglycemia by patients with type 1 diabetes. Diabetes Care 2015; 38: 29-33
- 31 Commission Directive 2009/113/EC of 25 August 2009 amending Directive 2006/126/EC of the European Parliament and of the council on driving licences. Official Journal of the European Union 2009; L 223: 31-35
- 32 Hammer M, Lammert M, Mejías SM. et al. Costs of managing severe hypoglycaemia in three European countries. J Med Econ 2009; 12: 281-290
- 33 Jakubczyk M, Lipka I, Pawęska J. et al. Cost of severe hypoglycaemia in nine European countries. J Med Econ 2016; 19: 973-982
- 34 Pöhlmann J, Mitchell BD, Bajpai S. et al. Nasal glucagon versus injectable glucagon for severe hypoglycemia: A cost-offset and budget impact analysis. J Diabetes Sci Technol 2019; 13: 910-918
- 35 Pacaud D, Hermann JM, Karges B. et al. Risk of recurrent severe hypoglycemia remains associated with a past history of severe hypoglycemia up to 4 years: Results from a large prospective contemporary pediatric cohort of the DPV initiative. Pediatr Diabetes 2018; 19: 493-500
- 36 Davis TM, Brown SG, Jacobs IG. et al. Determinants of severe hypoglycemia complicating type 2 diabetes: The Fremantle diabetes study. J Clin Endocrinol Metab 2010; 95: 2240-2247
- 37 Gubitosi-Klug RA, Braffett BH, White NH. et al. Risk of severe hypoglycemia in type 1 diabetes over 30 years of follow-up in the DCCT/EDIC study. Diabetes Care 2017; 40: 1010-1016
- 38 Jeon JY, Kim SR, Kim HJ. et al. Risk factors of severe hypoglycemia requiring medical assistance and neurological sequelae in patients with diabetes: A case-control study. Medicine (Baltimore) 2016; 95: e5365
- 39 Haymond MW, Liu J, Bispham J. et al. Use of glucagon in patients with type 1 diabetes. Clin Diabetes 2019; 37: 162-166
- 40 Villani M, Earnest A, Smith K. et al. Outcomes of people with severe hypoglycaemia requiring prehospital emergency medical services management: A prospective study. Diabetologia 2019; 62: 1868-1879
- 41 Heinemann L, Freckmann G, Ehrmann D. et al. Real-time continuous glucose monitoring in adults with type 1 diabetes and impaired hypoglycaemia awareness or severe hypoglycaemia treated with multiple daily insulin injections (HypoDE): a multicentre, randomised controlled trial. Lancet 2018; 391: 1367-1377
- 42 Wild D, von Maltzahn R, Brohan E. et al. A critical review of the literature on fear of hypoglycemia in diabetes: Implications for diabetes management and patient education. Patient Educ Couns 2007; 68: 10-15
- 43 Jódar-Gimeno E, Álvarez-Guisasola F, Ávila-Lachica L. et al. Quality of life and fear for hypoglycaemia in patients with type 2 diabetes mellitus. Rev Clin Esp 2015; 215: 91–97. [Article in English, Spanish]
- 44 Grammes J, Stock W, Mann CG. et al. Focus group study to identify the central facets of fear of hypoglycaemia in people with type 2 diabetes mellitus. Diabet Med 2017; 34: 1765-1772