Incidence of Hypoglycemia
in Insulin-treated Type 2 Diabetes Higher than
Previously Recognized
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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