Incidence and severity of hypoglycaemia in type 2 diabetes by treatment regimen: A UK multisite 12-month prospective observational study

被引:20
作者
Dunkley, Alison J. [1 ]
Fitzpatrick, Claire [1 ]
Gray, Laura J. [2 ]
Waheed, Ghazala [1 ]
Heller, Simon R. [3 ]
Frier, Brian M. [4 ]
Davies, Melanie J. [1 ]
Khunti, Kamlesh [1 ]
Millar-Jones, David
Diggle, Jane
Down, Su
Lowe, Joanne
Quigley, Richard
Brown, Pam
Campbell, Nigel
Fernando, Kevin
Gilani, Alia
Hadley-Brown, Martin
Hambling, Clare
Hamilton, Lesley
Kanumilli, Naresh
Lawrence, Stephen
McMorran, Jim
Milne, Nicola
Widdowson, Julie
机构
[1] Univ Leicester, Diabet Res Ctr, Leicester, Leics, England
[2] Univ Leicester, Dept Hlth Sci, Leicester, Leics, England
[3] Univ Sheffield, Dept Oncol & Metab, Sheffield, S Yorkshire, England
[4] Univ Edinburgh, Queens Med Res Inst, BHF Ctr Cardiovasc Sci, Edinburgh, Midlothian, Scotland
关键词
hypoglycaemia; incidence; observational study; primary care; treatment regimen; type; 2; diabetes; EUROPEAN ASSOCIATION; POSITION STATEMENT; PRIMARY-CARE; MANAGEMENT; FREQUENCY; EVENTS; RISK; HYPERGLYCEMIA; PREDICTORS; SYMPTOMS;
D O I
10.1111/dom.13690
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Aims To determine the incidence and severity of self-reported hypoglycaemia in a primary care population with type 2 diabetes. The study also aimed to compare incidence by treatment regimen. Materials and methods A prospective observational study in 17 centres throughout the UK was conducted. Recruitment was based on treatment regimen (metformin alone, sulphonylurea-, insulin- or incretin-based therapy). Participants were asked to keep a blood glucose diary and self-report hypoglycaemia episodes [non-severe (self-treated) and severe (requiring external help)] over a 12-month period. Results Three hundred and twenty-five participants were enrolled, of whom 274 (84%) returned >= 1 monthly diaries. Overall, 39% reported experiencing hypoglycaemia; 32% recorded >= 1 symptomatic, 36% >= 1 non-severe, and 7% >= 1 severe episodes. By treatment, incidence (events per person/year) for any hypoglycaemia type was 4.39 for insulin, 2.34 for sulphonylurea, 0.76 for metformin, and 0.56 for incretin-based therapy. Compared with metformin, risk of non-severe hypoglycaemia was 3 times higher for participants on sulphonylureas and > 5 times higher for those on insulin [incidence rate ratio (IRR) 3.02 (1.76-5.18), P < 0.001, and IRR 5.96 (3.48-10.2), P < 0.001, respectively]. For severe episodes, the incidence for sulphonylurea (0.09) was similar to metformin (0.07) and incretin-based therapy (0.07); for insulin the risk remained almost 5 times higher than metformin [incidence 0.32; IRR 4.55 (1.28-16.20), P = 0.019]. Conclusions Hypoglycaemia represents a substantial burden for people with type 2 diabetes. Sulphonylureas and insulin are both associated with a risk of reported non-severe hypoglycaemia, but only insulin with severe episodes. This suggests the importance of the continued use of sulphonylureas in appropriate patients with type 2 diabetes.
引用
收藏
页码:1585 / 1595
页数:11
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