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DOI: 10.1055/s-0043-112350
Self-reported Hypoglycaemic Events in 2 430 Patients with Insulin-treated Diabetes in the German Sub-population of the HAT Study
Publikationsverlauf
received 30. Dezember 2016
revised 24. Mai 2017
accepted 29. Mai 2017
Publikationsdatum:
27. Juli 2017 (online)
Abstract
Data concerning true hypoglycaemic incidence in insulin-treated patients with diabetes in real-world clinical practice are lacking in Germany. The aim of this analysis was to determine the incidence of hypoglycaemia experienced by the German cohort of patients enrolled in the global Hypoglycaemia Assessment Tool (HAT) study. This was a non-interventional, 6-month retrospective and 4-week prospective study using self-assessment questionnaires and patient diaries assessing patients aged ≥18 years in Germany, with type 1 diabetes (T1D) (n=811) or type 2 diabetes (T2D) (n=1 619) treated with insulin for >12 months. The primary endpoint was the percentage of patients experiencing ≥1 hypoglycaemic event during the prospective observational period (4 weeks after baseline). Predictive and continuous factors (such as age, gender, duration of insulin use and HbA1c) contributing to hypoglycaemia risk were explored.
During the prospective period, at least one hypoglycaemic event was reported by 81.3% of patients with T1D and 39.7% of patients with T2D, indicating that hypoglycaemia is a common acute complication among patients with insulin-treated diabetes. Severe hypoglycaemia was reported by 9.1% of patients with T1D and 5.4% of patients with T2D. Higher rates of any and severe hypoglycaemia were reported prospectively than retrospectively, regardless of diabetes type, indicating that patients retrospectively under-report hypoglycaemia. Prospective rates (events per patient-year) of any, nocturnal and severe hypoglycaemia were 80.3, 9.9 and 3.0 for T1D and 15.6, 2.4 and 1.1 for T2D, respectively. Given the potential for recall bias in retrospective reporting, this prospective assessment of hypoglycaemia appears more reliable than retrospective assessment.
Trial number: NCT01696266
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References
- 1 International Diabetes Federation. IDF Diabetes Atlas, 7th edn. 2016.Available at http://www.diabetesatlas.org (last accessed 22 June 2016).
- 2 Barnett AH, Cradock S, Fisher M. et al. Key considerations around the risks and consequences of hypoglycaemia in people with type 2 diabetes. Int J Clin Pract. 2010; 64: 1121-1129
- 3 Workgroup on Hypoglycemia, American Diabetes Association. Defining and reporting hypoglycemia in diabetes: a report from the American Diabetes Association Workgroup on Hypoglycemia. Diabetes Care. 2005; 28: 1245-1249
- 4 Zoungas S, Patel A, Chalmers J. ADVANCE Collaborative Group. et al. Severe hypoglycemia and risks of vascular events and death. N Engl J Med. 2010; 363: 1410-1418
- 5 Khunti K, Alsifri S, Aronson R. HAT Investigator Group. et al. Rates and predictors of hypoglycaemia in 27 585 people from 24 countries with insulin-treated type 1 and type 2 diabetes: the global HAT study. Diabetes Obes Metab. 2016; 18: 907-915
- 6 Hex N, Bartlett C, Wright D. et al. Estimating the current and future costs of Type 1 and Type 2 diabetes in the UK, including direct health costs and indirect societal and productivity costs. Diabet Med 2012; 29: 855-862
- 7 Graveling AJ, Deary IJ, Frier BM. Acute hypoglycemia impairs executive cognitive function in adults with and without type 1 diabetes. Diabetes Care. 2013; 36: 3240-3246
- 8 Brod M, Wolden M, Christensen T. et al. Understanding the economic burden of nonsevere nocturnal hypoglycemic events: impact on work productivity, disease management, and resource utilization. Value Health. 2013; 16: 1140-1149
- 9 Geelhoed-Duijvestijn PH, Pedersen-Bjergaard U, Weitgasser R. et al. Effects of patient-reported non-severe hypoglycemia on healthcare resource use, work-time loss, and wellbeing in insulin-treated patients with diabetes in seven European countries. J Med Econ 2013; 16: 1453-1461
- 10 Östenson CG, Geelhoed-Duijvestijn P, Lahtela J. et al. Self-reported non-severe hypoglycaemic events in Europe. Diabet Med 2014; 31: 92-101
- 11 Lüddeke HJ, Sreenan S, Aczel S. PREDICTIVE Study Group. et al. PREDICTIVE - a global, prospective observational study to evaluate insulin detemir treatment in types 1 and 2 diabetes: baseline characteristics and predictors of hypoglycaemia from the European cohort. Diabetes Obes Metab. 2007; 9: 428-434
- 12 Leiter LA, Boras D, Woo VC. Dosing irregularities and self-treated hypoglycemia in type 2 diabetes: results from the Canadian cohort of an international survey of patients and healthcare professionals. Can J Diabetes 2014; 38: 38-44
- 13 Munro N, Barnet AH. Incidence, worry and discussion about dosing irregularities and self-treated hypoglycaemia amongst HCPs and patients with type 2 diabetes: results from the UK cohort of the Global Attitudes of Patient and Physicians (GAPP2) survey. Int J Clin Pract. 2014; 68: 692-699
- 14 Pedersen-Bjergaard U, Pramming S, Thorsteinsson B. Recall of severe hypoglycaemia and self-estimated state of awareness in type 1 diabetes. Diabetes Metab Res Rev 2003; 19: 232-240
- 15 Elliott L, Fidler C, Ditchfield A. et al. Hypoglycemia event rates: a comparison between real-world data and randomized controlled trial populations in insulin-treated diabetes. Diabetes Ther 2016; 7: 45-60
- 16 Kulzer B, Seitz L, Kern W. Real-world patient-reported rates of non-severe hypoglycaemic events in Germany. Exp Clin Endocrinol Diabetes. 2014; 122: 167-172
- 17 World Medical Association Declaration of Helsinki: ethical principles for medical research involving human subjects. JAMA 2013; 310: 2191-2194
- 18 International Conference on Harmonisation. 1996; ICH Harmonised Tripartate Guideline. Good Clinical Practice 1996. Available at: http://www.ich.org/products/guidelines/efficacy/efficacy-single/article/good-clinical-practice.html (last accessed 12 April 2017).
- 19 Heller SR, Frier BM, Hersløv ML. et al. Severe hypoglycaemia in adults with insulin-treated diabetes: impact on healthcare resources. Diabet Med 2016; 33: 471-477
- 20 Köster I, Huppertz E, Hauner H. et al. Costs of Diabetes Mellitus (CoDiM) in Germany, direct per-capita costs of managing hyperglycaemia and diabetes complications in 2010 compared to 2001. Exp Clin Endocrinol Diabetes. 2014; 122: 510-516