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16-07-2019 | Diabetes | News | Article

Early hypoglycemia common after starting basal insulin therapy

medwireNews: Almost one in 10 people with type 2 diabetes who begin basal insulin therapy through the Medicare health program experience hypoglycemia within 6 months, US research suggests.

And those patients who do experience hypoglycemia have a 33% greater likelihood of discontinuing therapy for at least 90 days in the first year than patients without early hypoglycemia, and a 19% lower odds of being adherent (≥0.80 proportion of days covered), the researchers report in Diabetes, Obesity and Metabolism.

The increased risk for discontinuation remained significant during the longer 3-year follow-up, whereas there was no association with 3-year adherence.

The study involved 14,466 patients with type 2 diabetes who initiated basal insulin therapy between 2008 and 2012 according to outpatient prescription drug claims, 9.1% of whom experienced at least one hypoglycemic event within the first 6 months.

“Reducing the incidence of early hypoglycemia has the potential to improve insulin adherence and outcomes for patients with type 2 diabetes,” the team maintains, highlighting the need for physicians to emphasize the importance of glucose monitoring to their patients and ensure adequate patient education is in place.

The researchers report that “a unique finding” was the 20% increased odds of at least one early hypoglycemic event among the 60% of participants receiving low-income subsidies through part D prescription drug plans of the healthcare program.

Jalpa Doshi (University of Pennsylvania, Philadelphia, USA) and colleagues say that potential reasons for this may include lower education or a higher comorbidity burden in this group compared with other beneficiaries. They explain that these factors are consistent with social deprivation, which itself is a risk factor for hypoglycemic hospitalization.

Other characteristics linked with early hypoglycemia include female gender, which carried a 16% increased odds of an early hypoglycemic event and a high diabetes complication score index, which carried an 8% increased odds.

Connective tissue disease or rheumatic disease carried a 43% increased odds of an early hypoglycemic event and hypoglycemia during the baseline period was associated with a 4.24-fold increased odds.

The researchers highlight the association with connective tissue disease and suggest that the patients prone to hypoglycemia may have undiagnosed latent autoimmune diabetes and that their total daily insulin need is relatively low.

The team concludes: “Given that this study showed that patients who experienced early hypoglycemia had poorer adherence and persistence, such patients may benefit from more frequent and less aggressive insulin titration, more frequent healthcare professional visits, and specialist referrals during the first year of [basal insulin] initiation to address diabetes education and specialist care needs, and to improve glycemic control without the high risk of early hypoglycemia.”

By Anita Chakraverty

medwireNews is an independent medical news service provided by Springer Healthcare. © 2019 Springer Healthcare part of the Springer Nature group

Diabetes Obes Metab 2019; doi: 10.1111/dom.13832