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. 2017 Oct 9;56(4):244-250.
doi: 10.1515/sjph-2017-0033. eCollection 2017 Oct.

Self-reported Hypoglycaemia in Patients treated with Insulin: A Large Slovenian Retrospectively-prospective Study

Draženka Pongrac Barlovič  1 , Andrej Zavratnik  2 , Aleš Skvarča  1 , Karmen Janša  3 , Bojana Vukelič  4 , Marjeta Tomažič  1 , Maja Ravnik Oblak  1
Affiliations

Self-reported Hypoglycaemia in Patients treated with Insulin: A Large Slovenian Retrospectively-prospective Study

Draženka Pongrac Barlovič et al. Zdr Varst. .

Abstract
in English, Slovenian

Introduction: Hypoglycaemia is the major barrier for glycaemic _target achievement in patients treated with insulin. The aim of the present study was to investigate real-world incidence and predictors of hypoglycaemia in insulin-treated patients.

Methods: More than 300 consecutive patients with type 1 or type 2 diabetes treated with insulin were enrolled during regular out-patient visits from 36 diabetes practices throughout the whole country. They completed a comprehensive questionnaire on hypoglycaemia knowledge, awareness, and incidence in the last month and last six months. In addition, in the prospective part, patients recorded incidence of hypoglycaemic events using a special diary prospectively on a daily basis, through 4 weeks.

Results: At least one hypoglycaemic event was self-reported in 84.1%, and 56.4% of patients with type 1 and type 2 diabetes, respectively, during the prospective period of 4 weeks. 43.4% and 26.2% of patients with type 1 and type 2 diabetes, respectively, experienced a nocturnal hypoglycaemic event. In the same time-period, severe hypoglycaemia was experienced by 15.9% and 7.1% of patients with type 1 and type 2 diabetes, respectively. Lower glycated haemoglobin was not a significant predictor of hypoglycaemia.

Conclusions: Rates of self-reported hypoglycaemia in patients treated with insulin in the largest and most comprehensive study in Slovenia so far are higher than reported from randomised control trials, but comparable to data from observational studies. Hypoglycaemia incidence was high even with high glycated haemoglobin values.

Uvod: Hipoglikemije so glavni omejujoči dejavnik varnega doseganja glikemičnih ciljev pri bolnikih s sladkorno boleznijo, ki se zdravijo z insulinom. Namen te raziskave je bil raziskati pojavnost hipoglikemij in napovedne dejavnike hipoglikemij v vsakodnevnem življenju bolnikov s sladkorno boleznijo.

Metode: V raziskavo smo vključili več kot 300 zaporednih bolnikov s sladkorno boleznijo tipa 1 ali 2, zdravljenih z insulinom, iz 36 diabetoloških ambulant po državi. Bolniki so izpolnili natančen vprašalnik, ki je poizvedoval o znanju o hipoglikemijah, njihovemu zaznavanju in pojavnosti v zadnjem mesecu in v zadnjih šestih mesecih. V nadaljevalnem, prospektivnem delu raziskave, ki je trajal 1 mesec, so bolniki vsakodnevno beležili dnevnik hipoglikemij, kamor so sproti vpisovali, ali so doživeli hipoglikemijo.

Rezultati: V raziskavo je bilo vključenih 84 bolnikov s sladkorno boleznijo tipa 1 in 227 bolnikov s sladkorno boleznijo tipa 2. Med enomesečnim prospektivnim delom raziskave je 84,1% bolnikov s sladkorno boleznijo tipa 1 in 56,4% bolnikov s sladkorno boleznijo tipa 2 poročalo, da so doživeli vsaj eno hipoglikemijo. Nočno hipoglikemijo je doživelo 43,4% bolnikov s sladkorno boleznijo tipa 1 in 26,2% bolnikov s sladkorno boleznijo tipa 2. Hudo hipoglikemijo je doživelo 15,9 % bolnikov s sladkorno boleznijo tipa 1 in 7,1% bolnikov s sladkorno boleznijo tipa 2. Nižji glikiran hemoglobin ni bil napovedni dejavnik za pojav hipoglikemij.

Zaključki: Incidenca hipoglikemij, o katerih so poročali sami bolniki, zdravljeni z insulinom, je v doslej največji raziskavi o hipoglikemijah na Slovenskem višja kot v velikih randomiziranih prospektivnih raziskavah, a primerljiva kot v podobnih opazovalnih raziskavah iz vsakodnevnega življenja. Incidenca hipoglikemij je visoka tudi pri bolnikih z visokim glikiranim hemoglobinom.

Keywords: Slovenia; hypoglycaemia; insulin treatment; type 1 diabetes; type 2 diabetes.

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Conflict of interest statement

Conflicts of interest: The authors declare that no conflicts of interest exist.

Figures

Figure 1
Figure 1
Hypoglycaemia incidence depending on the retrospective or prospective recall by patients.
Figure 2
Figure 2
Hypoglycaemia incidence and HbA1c.
Figure 3
Figure 3
Actions resulting from hypoglycaemia in patients with Type 1 and Type 2 diabetes. (Statistically significant differences are marked with *).
See this image and copyright information in PMC

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