Incidence of severe hypoglycemia rises in German diabetes population
MedWire News: The incidence of severe hypoglycemia in patients with Type 2 diabetes has increased considerably over the last 10 years, show results of a study of German diabetic patients.
The increase appears to be linked to the intensification of antihyperglycemic therapy in these patients, particularly those with increasing comorbidity, say Andreas Holstein (Clinic Lippe-Detmold, Detmold, Germany) and colleagues.
"Severe hypoglycemia remains the limiting factor in successful metabolic control of diabetes," say the researchers. "In patients with long-standing and complicated diabetes mellitus, severe hypoglycemia may even increase cardiovascular and all-cause mortality."
The team compared incidences of severe hypoglycemia and its clinical characteristics in patients screened at the Lippe-Detmold Hospital over two 4-year periods; January 1997 to December 2000, and January 2007 to December 2010. Severe hypoglycemia was defined as a symptomatic event requiring treatment with intravenous glucose, and a blood glucose measurement of less than 50 mg/dL.
The researchers report that from 1997-2007, a total of 264 cases of severe hypoglycemia were registered among 38,572 patients who attended the hospital emergency department. This number increased to 495 of 59,990 patients between 2007 and 2010, meaning the frequency of severe hypoglycemia among the admissions increased from 0.68% to 0.83% over the 10-year period.
During both the 1997-2000 and 2007-2010 periods, severe hypoglycemia occurred in patients with Type 2 diabetes more frequently than it did in those with Type 1 diabetes, at 56% versus 35% and 53% versus 38%, respectively.
The team found that the number of concomitant diseases among hypoglycemic individuals with Type 2 diabetes increased significantly from a mean of 3.6 in 1997-2000 to 4.4 in 2007-2010. And the use of co-medication not related to diabetes also significantly increased, from a mean of 3.3 to 7.7 drugs.
"The overwhelming proportion of our hypoglycemic subjects with Type 2 diabetes were characterized by advanced age, long-standing diabetes, comorbidities, and extensive co-medication," write the authors in Diabetes Care.
In addition, compared with the earlier period, there was a significant increase in the intensification of insulin therapy among Type 2 diabetes patients during the 2007-2010 period. The authors also note that a large proportion of Type 2 diabetes patients had an inappropriately low glycated hemoglobin (HbA1c) level during this time.
"Their low HbA1c of 6.6% seems to be an indicator for recurrent but possibly unnoticed severe hypoglycemia and raises the question of dangerous overtreatment and adequate targets in elderly patients," say Holstein et al.
"A critical definition of the metabolic target tailored to individual circumstances will be vital for minimizing the risk of hypoglycemia as a potentially life-threatening condition," they conclude.
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By Sally Robertson