Item 5: Incidence of Hypoglycemia in Insulin-treated Type 2 Diabetes Higher tha

Hypoglycemia may be more common patients with type 2 diabetes who are treated with insulin than was previously thought.

The prevalence of hypoglycemia is generally considered to be lower in patients with insulin-treated type 2 diabetes compared with type 1 diabetes. However, increasing emphasis on strict glycaemic control has led to earlier introduction of insulin and more intensive regimens for type 2 diabetics in recent years, which may increase the risk of hypoglycemia.

J.N. Henderson, of the Royal Infirmary of Edinburgh, United Kingdom, and colleagues performed a retrospective survey to determine the frequency of hypoglycemia in a heterogeneous group of people with insulin-treated type 2 diabetes.

The number of hypoglycemic episodes occurring in the previous year was determined by interview for 215 patients (median age, 68 years). All patients included in the survey had been treated with 2 or more daily insulin injections for at least 1 year.

According to Dr. Henderson, 73% of the patients had experienced 1 or more episodes of hypoglycemia since starting insulin therapy. Fifteen percent experienced a total of 60 episodes of severe hypoglycemia in the preceding year, resulting in an estimated incidence rate of 0.28 episodes per patient year for the entire group.

The frequency of severe hypoglycemia increased with age and duration of diabetes (P < .05). In addition, 13 patients with evidence of impaired awareness of hypoglycemia had a 9-fold higher rate of severe hypoglycemia. Neuroglycopenic symptoms, such as confusion and drowsiness, were more evident in patients with impaired awareness, whereas autonomic symptoms, such as sweating and shaking, were more common overall.

The results of this survey indicate that hypoglycemia is less common in patients with type 2 diabetes than type 1 diabetes. However, the researchers note that, "severe hypoglycemia in insulin-treated type 2 diabetes is more common that has been previously recognised."

"With increasing duration of treatment with insulin, [the frequency] may begin to approach that observed in type 1 diabetes," they propose. Diabet Med 2003 Dec;20:12:1016-21

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