Materiały źródłowe

• #1

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6117835/

  Hypoglycemia is the most common and often treatment-limiting serious adverse effect of diabetes therapy. […] We review the epidemiology of hypoglycemia in type 2 diabetes, discuss key risk factors, and introduce potential prevention strategies. […] Reported rates of hypoglycemia in type 2 diabetes vary widely as there is marked heterogeneity in how hypoglycemia is defined, measured, and reported. […] Hypoglycemia is most common among older patients with multiple or advanced comorbidities, patients with long diabetes duration, or patients with a prior history of hypoglycemia. […] Clinical decision support tools may help identify at-risk patients. […] Prospective trials of efforts to reduce hypoglycemia risk are needed, and there is emerging evidence supporting multidisciplinary interventions including treatment deintensification, diabetes self-management, and social support.

• #1 Hypoglycaemia in diabetes mellitus: epidemiology and clinical implications | Nature Reviews Endocrinology

  https://www.nature.com/articles/nrendo.2014.170

  Hypoglycaemia, a common adverse effect of treatment of diabetes mellitus with insulin and sulphonylureas, is associated with impairment of cognitive function, which can have important consequences on everyday behaviour. […] Adults with type 1 diabetes mellitus have 2 episodes of mild hypoglycaemia per week; the annual prevalence of severe hypoglycaemia is 30%, with several factors, such as long disease duration, increasing its incidence. […] Adults with insulin-treated type 2 diabetes mellitus experience a lower frequency of mild and severe hypoglycaemia episodes than those with type 1 diabetes mellitus, but frequency rises progressively with increasing duration of insulin therapy. […] Prevention of hypoglycaemia is an important part of diabetes mellitus management and strategies include patient education, glucose monitoring, appropriate adjustment of diet and medications in relation to everyday circumstances including physical exercise, and the application of new technologies such as real-time continuous glucose monitoring, modified insulin pumps and the artificial pancreas.

• #1 Hypoglycemia – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK534841/

  Hypoglycemia is common with type 1 diabetes, particularly in those patients receiving intensive insulin therapy. Severe hypoglycemic events have reportedly been anywhere between 62 to 320 episodes per 100 patient-years in type 1 diabetes. […] As opposed to patients who have type 1 diabetes and require insulin therapy exclusively, patients with type 2 diabetes experience hypoglycemia relatively less frequently compared to patients with type 1 diabetes. This can be, in part, due to pharmacotherapies that do not induce hypoglycemia, like metformin. The incidence of hypoglycemia in patients with type 2 diabetes has been reportedly approximately 35 episodes for 100 patient years. […] There are no reported disparities in incidents based on gender.

• #1 Hypoglycemia: Practice Essentials, Background, Pathophysiology

  https://emedicine.medscape.com/article/122122-overview

  The incidence of hypoglycemia in a population is difficult to ascertain. Patients and physicians frequently attribute symptoms (eg, anxiety, irritability, hunger) to hypoglycemia without documenting the presence of low blood sugar. The true prevalence of hypoglycemia, with blood sugar levels below 50 mg/dL, is generally 5-10% of people presenting with symptoms suggestive of hypoglycemia. […] A Brazilian study, by Lamounier et al, found that during a 4-week prospective evaluation period, at least one hypoglycemic event occurred in 91.7% of study patients with type 1 diabetes and in 61.8% of those with type 2 diabetes. This included nocturnal hypoglycemia in 54.0% and 27.4% of patients, respectively; asymptomatic hypoglycemia in 20.6% and 10.6% of patients, respectively; and severe hypoglycemic events in 20.0% and 10.3% of patients, respectively.

• #1 Epidemiology and risk factors of hypoglycemia in subjects with type 1 diabetes in Brazil: a cross-sectional, multicenter study – Archives of Endocrinology and Metabolism

  https://www.aem-sbem.com/article/epidemiology-and-risk-factors-of-hypoglycemia-in-subjects-with-type-1-diabetes-in-brazil-a-cross-sectional-multicenter-study/

  Epidemiology and risk factors of hypoglycemia in subjects with type 1 diabetes in Brazil: a cross-sectional, multicenter study […] The aim of this study was to investigate the factors associated with hypoglycemia and severe hypoglycemia (SH) in individuals with type 1 diabetes mellitus (T1D) in Brazil. […] This multicenter, cross-sectional study was conducted between August 2011 and August 2014 across 10 Brazilian cities. The data were obtained from 1,760 individuals with T1D. Sociodemographic and clinical characteristics related to hypoglycemic events in the previous 4 weeks were evaluated. […] Of 1,760 individuals evaluated, 1,319 (74.9%) reported at least one episode of hypoglycemia in the previous 4 weeks. The main factors associated with hypoglycemia were lower hemoglobin A1c (HbA1c) level, better adherence to self-monitoring of blood glucose (SMBG), and higher education level. Episodes of SH were reported by 251 (19%) individuals who, compared with subjects with nonsevere hypoglycemia, received lower doses of prandial insulin and higher doses of basal insulin, in addition to reporting less frequent use of long-acting basal insulin analogs. The percentage of SH episodes was evenly distributed across all ranges of HbA1c levels, and there were no correlations between the mean number of nonsevere or severe hypoglycemic events and HbA1c values. Higher alcohol consumption and more frequent hospitalizations were independently associated with SH.

• #1

  https://journals.lww.com/jhrr/fulltext/2018/05020/epidemiology_of_hypoglycemia_among_ambulatory_type.1.aspx

  The study was aimed at describing the epidemiology of hypoglycemia among ambulatory type 2 diabetic patients in a primary care clinic in Eastern Nigeria. […] The prevalence of hypoglycemia was 35.2%. Hypoglycemia occurred predominantly among the elderly (72.5%), male gender (54.9%), outside home environment (72.5%), during the daytime (82.4%), duration of diabetes 1 year (58.8%), and patients on insulin secretagogues alone (46.2%). […] The study has shown variable epidemiology of hypoglycemia. The incident occurred predominantly among the elderly, male gender, during daytime, outside home environment, duration of diabetes 1 year, and patients on insulin and insulin secretagogues. […] Effective reduction of hypoglycemic crisis syndrome in diabetic Nigerians depends largely on the adequate understanding of its epidemiology.

• #1 Severe Hypoglycemia Linked to Increased Risk of Death in People With Diabetes | Johns Hopkins | Bloomberg School of Public Health

  https://publichealth.jhu.edu/2017/severe-hypoglycemia-linked-to-increased-risk-of-death-in-people-with-diabetes

  A single instance of blood sugar falling so low as to require an emergency department visit was associated with nearly double the risk of cardiovascular disease or death, finds a new Johns Hopkins Bloomberg School of Public Health study of older adults with type 2 diabetes. […] Additionally, using data from a large longitudinal study, the researchers found that one third of the older adults with diabetes who had experienced a severe low blood sugar episode (hypoglycemia) died within three years of the incident. […] The researchers say that their findings suggest that doctors might want to pay special attention to patients who have been sent to the emergency department for hypoglycemia after losing consciousness, having a seizure or experiencing another serious health event. […] Hypoglycemia is clearly an under-recognized risk factor for death and cardiovascular disease in people with diabetes.

• #1

  https://link.springer.com/article/10.1007/s11892-018-1018-0

  This study analyzed 594,146 hospitalizations among commercially insured and Medicare Advantage beneficiaries with diabetes between 2009 and 2014 and found that 1.3% of all hospitalizations were for the primary diagnosis of hypoglycemia. […] This study examined the prevalence of severe hypoglycemia requiring emergency department care or hospitalization among 917,440 adults with diabetes (not separated by diabetes type) within a large integrated healthcare delivery system in the USA between 2005 and 2011. Annual rates of severe hypoglycemia ranged from 1.4 to 1.6/100 person-years and were higher among older patients; patients treated with insulin, sulfonylurea, and beta-blockers; and patients with chronic kidney disease, heart failure, cardiovascular disease, depression, and higher HbA1c. […] This study demonstrated that patient self-report of severe hypoglycemia was associated with 3.4-fold increase in 5-year all-cause mortality after controlling for diabetes type, comorbidity burden, and glycemic control. This finding reinforced the importance of screening patients at risk of hypoglycemia at each clinical encounter.

• #1

  https://link.springer.com/article/10.1007/s11892-018-1018-0

  Hypoglycemia is most common among older patients with multiple or advanced comorbidities, patients with long diabetes duration, or patients with a prior history of hypoglycemia. Insulin and sulfonylurea use, food insecurity, and fasting also increase hypoglycemia risk. […] Prospective trials of efforts to reduce hypoglycemia risk are needed, and there is emerging evidence supporting multidisciplinary interventions including treatment de-intensification, use of diabetes technologies, diabetes self-management, and social support. […] Hypoglycemia among patients with type 2 diabetes is common. Patient-centered multidisciplinary care may help proactively identify at-risk patients and address the multiplicity of factors contributing to hypoglycemia occurrence. […] This study demonstrated that only 5% of severe hypoglycemic events experienced by patients with diabetes culminate in an emergency department visit or hospitalization event.

• #1 Hypoglycemia in diabetes: An update on pathophysiology, treatment, and prevention

  https://www.wjgnet.com/1948-9358/full/v12/i12/2036.htm

  The current classification of hypoglycemic episodes in diabetes includes three levels corresponding to the severity of hypoglycemia. […] Risk factors for hypoglycemia can be from therapeutic hyperinsulinemia or failure of defense mechanisms from a drop in plasma glucose concentration. […] The above defense mechanisms are often impaired in patients with diabetes and significant beta-cell failure who lack an initial response to a drop in insulin. […] It is believed that the impaired sympathoadrenal response is secondary to repeated episodes of hypoglycemia that reduce the autonomic response to other hypoglycemic events. […] Hypoglycemia causes physical and psychological morbidity in diabetic patients. […] Clinical and epidemiological studies based on tens of thousands of patients with type 1 and type 2 diabetes from a variety of health services in different world regions showed a 1.5- to 6-fold increase in the risk of cardiovascular events and mortality among patients who experienced severe hypoglycemia.

• #1 The Impact of Hypoglycemia on Patients with Diabetes Mellitus: A Cross-Sectional Analysis

  https://www.mdpi.com/2077-0383/11/3/626

  The increasing mortality and morbidity in patients with diabetes mellitus constitute a severe public health problem. […] In this study, we performed a cross-sectional analysis among 300 Polish participants with type 1 and type 2 diabetes to determine and classify risk factors associated with increased incidences of hypoglycemia. […] Approximately 2–4% of deaths of DM patients are due to hypoglycemic episodes. […] The rate of exhibiting hypoglycemic episodes was 62.0% (186/300). […] The presence of hypoglycemia increases the risk of severe hypoglycemia (six-fold for type 1 diabetes mellitus and 17-fold for type 2 diabetes mellitus). […] Understanding the interactions between diabetes and sociodemographic, environmental, or other disease-related risk factors may provide new strategies to optimize glycemic control and reduce the occurrence of hypoglycemia.

• #1 Temporal changes in frequency of severe hypoglycemia treated by emergency medical services in types 1 and 2 diabetes: a population-based data-linkage cohort study | Cardiovascular Diabetology – Endocrinology Reports | Full Text

  https://clindiabetesendo.biomedcentral.com/articles/10.1186/s40842-017-0045-0

  Almost 20 years ago, the frequencies of severe hypoglycemia requiring emergency medical treatment were reported in people with types 1 and 2 diabetes in the Tayside region of Scotland. […] The present population-based data-linkage cohort study aimed to ascertain whether a temporal change has occurred in the incidence rates of hypoglycemia requiring emergency medical services in people with types 1 and 2 diabetes. […] The incidence rate of hypoglycemia requiring emergency medical treatment had significantly fallen from 0.115 to 0.082 events per person per year in type 1 diabetes, and from 0.118 to 0.037 in insulin-treated type 2 diabetes. […] Although from 1998 to 2012 the incidences of hypoglycemia requiring emergency medical services appeared to have declined by a third in type 1 diabetes and by two thirds in insulin-treated type 2 diabetes, because the prevalence of diabetes was higher, the number of severe hypoglycemia events requiring emergency medical treatment was greater.

• #1 Severe hypoglycemia as a risk factor for cardiovascular outcomes in patients with type 2 diabetes: is it preventable?

  https://www.e-jcpp.org/journal/view.php?doi=10.36011/cpp.2022.4.e13

  Hypoglycemia in people with type 2 diabetes mellitus (T2DM) is troublesome and an important barrier to diabetes management. […] Severe hypoglycemia (SH), defined as critical events characterized by altered mental and/or physical status requiring assistance for recovery, is considered an advanced and life-threatening form of hypoglycemia. […] The detection of SH is an important issue because it is associated with further adverse clinical outcomes such as cardiovascular events, mortality, cognitive impairment, and decreased quality of life. […] By identifying the potential risk factors for SH and introducing measures to minimize SH, SH itself and subsequent harmful clinical outcomes could be prevented in people with T2DM. […] The prevalence of SH events in T2DM patients increased from 2002 to 2012; however, it decreased between 2012 and 2019.

• #1 Epidemiology and outcomes of hypoglycemia in patients with advanced diabetic kidney disease on dialysis: A national cohort study | PLOS One

  https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0174601

  Patients with advanced diabetic kidney disease (DKD) behave differently to diabetic patients without kidney disease. […] We aimed to investigate the associations of hypoglycemia and outcomes after initiation of dialysis in patients with advanced DKD on dialysis. […] 19.18% patients had at least one hypoglycemia episode during 1-year period before initiation of dialysis. […] Advanced DKD patients with higher adapted Diabetes Complications Severity Index (aDCSI) scores were associated with more frequent hypoglycemia (P for trend 0.001). […] Mortality and subsequent severe hypoglycemia after dialysis both increased with number of hypoglycemic episodes. […] The rate of severe hypoglycemia was high in advanced DKD patients. […] Hypoglycemic episodes were associated with subsequent hypoglycemia and mortality after initiation of dialysis. […] We studied the associations and further study is needed to establish cause. […] In addition, more attention is needed for hypoglycemia prevention in advanced DKD patients, especially for those at risk patients.

• #1 Prevalence and predictors of hypoglycemia in older outpatients with type 2 diabetes mellitus | PLOS One

  https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0309618

  The prevalence of type 2 diabetes (DM) has been increasing globally, particularly among older adults who are more susceptible to DM-related complications. Elderly individuals with diabetes are at higher risk of developing hypoglycemia compared with younger diabetes patients. Hypoglycemia in elderly patients can result in serious consequences such as cognitive changes, increased risk of falls, heart and other vascular problems, and even high mortality rate. […] To assess prevalence, and factors associated with hypoglycemia events among geriatric outpatients with type 2 diabetes mellitus. […] Hypoglycemia was prevalent in 21.7% of the patients. […] Insulin administration was significantly associated with more hypoglycemic events compared to other antidiabetic medication. […] Patients with liver diseases had a significantly higher risk of hypoglycemia, with odds 7.43 times higher than patients without liver diseases.

• #1 Impaired hypoglycemia awareness in diabetes: epidemiology, mechanisms and therapeutic approaches | Klimontov | Diabetes mellitus

  https://www.dia-endojournals.ru/jour/article/view/9597/en_US?locale=en_US

  Impaired awareness of hypoglycemia (IAH) is a frequent complication of insulin therapy. Up to half insulin-treated individuals with type 1 and type 2 diabetes report the problems with hypoglycemia awareness, and 15-25% of patients have a permanent IAH. […] A growing body of evidence indicates that IAH is a reversible condition. If the syndrome is present, the hypoglycemia avoidance should be primary goal of the treatment. […] The diabetes management in patients with IAH is time-consuming and expensive. Therefore, step-by-step approach, from insulin personalization and therapeutic training to advanced medical technologies, should be recommended for these patients.

• #1

  https://grantome.com/grant/NIH/R01-DK103721-04

  Most patients with type 2 diabetes are prescribed medications to lower glucose levels and reduce the risk of long-term complications. Severe hypoglycemia (SH) occurs as an unintended consequence of medications (i.e., an iatrogenic effect) and is defined as a low blood glucose level for which the patient requires assistance. […] Despite advances in pharmacotherapy, SH leading to emergency department (ED) visits or hospitalization has emerged as one of the most prevalent complications of diabetes treatment and is a critical public health concern. One in four emergency hospitalizations for adverse drug events among older adults is due to SH. […] This study will 1) provide new SH ascertainment tools to improve surveillance nationwide and thereby enable a more comprehensive understanding of SH epidemiology; and 2) provide valid estimates of change in SH risk associated with initiation of medications commonly used by people with diabetes, thus helping providers and patients individualize diabetes management while minimizing the risk of SH.

• #1 Hypoglycemia – Epidemiology Forecast to 2030 – Market Research Reports & Consulting | GlobalData UK Ltd.

  https://www.globaldata.com/store/report/hypoglycemia-epidemiology-analysis/

  GlobalData epidemiologists forecast that the diagnosed incident cases of hypoglycemia attributed to T1D and T2D in the 7MM will grow by an annual growth rate (AGR) of 0.21% over the next 10 years, from 1,483,850 cases in 2020 to 1,515,114 cases in 2030. Diagnosed incident cases of non-diabetic hypoglycemia will increase from 479,409 cases in 2020 to 489,344 cases in 2030 in the 7MM, at an AGR of 0.21%. These trends mirror changes in the underlying, at-risk populations, such as the rising incidence of T2D, the most common type of diabetes. While hypoglycemia has long been recognized as an inevitable consequence of diabetes therapy, it is being increasingly viewed as a potentially preventable cause of impaired quality of life and mortality. […] The Hypoglycemia Epidemiology Report and Model provide an overview of the risk factors, comorbidities, and global trends of Hypoglycemia in the seven major markets (7MM: US, France, Germany, Italy, Spain, UK, and Japan).

• #1 Hypoglycemia – Wikipedia

  https://en.wikipedia.org/wiki/Hypoglycemia

  Hypoglycemia is common in people with type 1 diabetes, and in people with type 2 diabetes taking insulin, glinides, or sulfonylurea. It is estimated that type 1 diabetics experience two mild, symptomatic episodes of hypoglycemia per week. Additionally, people with type 1 diabetes have at least one severe hypoglycemic episode per year, requiring treatment assistance. In terms of mortality, hypoglycemia causes death in 6-10% of type 1 diabetics. […] In those with type 2 diabetes, hypoglycemia is less common compared to type 1 diabetics, because medications that treat type 2 diabetes like metformin, glitazones, alpha-glucosidase inhibitors, glucagon-like peptide 1 agonists, and dipeptidyl peptidase IV inhibitors, do not cause hypoglycemia. Hypoglycemia is common in type 2 diabetics who take insulin, glinides, or sulfonylurea. Insulin use remains a key risk factor in developing hypoglycemia, regardless of diabetes type.

• #1

  https://www.healio.com/news/primary-care/20180416/small-proportion-of-hypoglycemia-events-captured-by-surveillance

  Pharmacologically treated patients with diabetes commonly reported experiencing severe hypoglycemic events; however, health care utilization-based surveillance captured only about 5% of self-reported events, according to findings published in JAMA Internal Medicine. […] Data indicated that 11.7% of participants experienced one or more severe hypoglycemia events that required third party assistance within the past year. A hypoglycemic event resulting in ED or hospital utilization occurred in only 0.8% of participants. Additionally, 5.2% of participants who reported having severe hypoglycemia were admitted to the ED or hospital. […] These findings suggest that current surveillance grossly underestimates the overall burden of severe hypoglycemia, according to Karter and colleagues. […] Because most severe hypoglycemic events occur outside of the health care system, a more complete understanding of the burden of severe hypoglycemia will require collecting self-reported events, they wrote. […] Determining the total burden of severe hypoglycemia, not just the small subset of events leading to health care utilization, will better inform clinical decision making, public health policy, and quality measure development to enhance patient safety, they concluded.

• #1 Variation in hypoglycemia ascertainment and report in type 2 diabetes observational studies: a meta-epidemiological study | BMJ Open Diabetes Research & Care

  https://drc.bmj.com/content/9/1/e001906

  Hypoglycemia is a common, serious, yet potentially preventable, adverse health outcome in the management of type 2 diabetes. Hypoglycemia prevention is predicted on the ability to capture, track and evaluate events as they occur in real-world practice. In this meta-epidemiological review of observational studies of patients with type 2 diabetes, we found substantial heterogeneity in the definition, ascertainment and report of hypoglycemia, particularly for non-severe events. […] Recognizing the importance of a uniform definition for hypoglycemia, on 21 November 2016, the IHSG proposed a taxonomy for non-severe (further subdivided into level 1 and level 2) and severe (level 3) hypoglycemia. […] The marked heterogeneity in how hypoglycemia is defined, documented and reported is a major barrier to assessing its prevalence, identifying highest risk subpopulations, promoting screening for and disclosure of events and developing prevention strategies.

• #1 Association Between Trajectory of Severe Hypoglycemia and Dementia in Patients With Type 2 Diabetes: A Population-based Study

  https://www.jstage.jst.go.jp/article/jea/32/9/32_JE20200518/_article

  Background: We aimed to investigate associations between exposure to various trajectories of severe hypoglycemic events and risk of dementia in patients with type 2 diabetes. […] In 20022003, 677,618 patients in Taiwan were newly diagnosed as having type 2 diabetes. Among them, 35,720 (5.3%) experienced severe hypoglycemic events during the 3-year baseline period following diagnosis. […] After a median follow-up 6.70 and 6.10 years for patients with and without severe hypoglycemia at baseline, respectively, 1,952 (5.5%) individuals with severe hypoglycemia and 23,492 (3.7%) without developed dementia during follow-up, for incidence rates of 109.80 and 61.88 per 10,000 person-years, respectively. […] Four groups of severe hypoglycemia trajectory were identified with a proportion of 18.06%, 33.19%, 43.25%, and 5.50%, respectively, for Groups 1 to 4. […] Our analysis highlighted that early manifestation of severe hypoglycemic events may contribute more than does late manifestation to the risk of dementia among individuals newly diagnosed as having type 2 diabetes.

• #1 Dementia in Diabetes: The Role of Hypoglycemia

  https://www.mdpi.com/1422-0067/24/12/9846

  Huang et al. conducted a systematic review of 10 cohort studies that encompassed Western and Asian populations, aiming to identify the risk of developing dementia secondary to hypoglycemic episodes (1 episode or >1 episode) in both T1D and T2D, with the controls being diabetics with no experience of hypoglycemic episodes. This meta-analysis showed a hazard ratio (HR) of 1.44 (95% CI: 1.26, 1.65 I² = 89% p < 0.00001) for developing dementia as a result of single or multiple severe hypoglycemic episodes requiring hospital admission. [...] Another meta-analysis conducted by Mattihsent et al. on American, European, and Asian populations involved the analysis of 44 studies (N = 2,507,434) and revealed an association of hypoglycemia with dementia, with a pooled OR of 1.50 (95% CI 1.29–1.74). Taken together, the available literature on the association of hypoglycemia and dementia suggests a significant correlation amongst multiple population groups.

• #1

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6117835/

  Hypoglycemia among patients with type 2 diabetes is common. […] Real-world data on hypoglycemia rates and risk factors are necessary to inform patients and healthcare providers about the benefits and potential harms of glucose-lowering therapies, facilitate shared decision making, and guide clinical practice.

• #1 Hypoglycemia in diabetes: An update on pathophysiology, treatment, and prevention

  https://www.wjgnet.com/1948-9358/full/v12/i12/2036.htm

  It is very important to control diabetes in pregnant women to prevent maternal and fetal complications. […] At any given moment persons with diabetes constitute about 30 percent of hospitalized patients. […] The approach to hypoglycemia prevention includes patient education, appropriate dietary and exercise regimens, glucose monitoring, medication adjustment, and close clinical supervision. […] The use of continuous glucose monitoring (CGM) contributed to improved control and reduction of 0.3%-0.6% in HbA1c. […] For patients with type 1 diabetes who experience recurrent episodes of hypoglycemia and/or hypoglycemia unawareness, CGM technology may be useful, though its long-term efficacy has not yet been determined.

• #2 Hypoglycemia in diabetes: An update on pathophysiology, treatment, and prevention

  https://www.wjgnet.com/1948-9358/full/v12/i12/2036.htm

  Hypoglycemia is a common complication in patients with diabetes, mainly in those treated with insulin, sulfonylurea, or glinide. Impairments in counterregulatory responses and hypoglycemia unawareness constitute the main risk factors for severe hypoglycemia. Episodes of hypoglycemia are associated with physical and psychological morbidity. The fear of hypoglycemia constitutes a barrier that impairs the patients ability to reach good glycemic control. […] Hypoglycemia is defined as a condition where plasma glucose concentration is low, which may expose patients to possible harm. This is common amongst persons who have type 1 diabetes, with an annual incidence of severe hypoglycemia ranging from 3.3% to 13.5%. […] In patients with diabetes, it is not easy to determine a specific plasma glucose concentration that is diagnostic of hypoglycemia, because the threshold for the appearance of hypoglycemia symptoms varies among patients.

• #2 Hypoglycemia – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK534841/

  Hypoglycemia is common with type 1 diabetes, particularly in those patients receiving intensive insulin therapy. Severe hypoglycemic events have reportedly been anywhere between 62 to 320 episodes per 100 patient-years in type 1 diabetes. […] As opposed to patients who have type 1 diabetes and require insulin therapy exclusively, patients with type 2 diabetes experience hypoglycemia relatively less frequently compared to patients with type 1 diabetes. This can be, in part, due to pharmacotherapies that do not induce hypoglycemia, like metformin. The incidence of hypoglycemia in patients with type 2 diabetes has been reportedly approximately 35 episodes for 100 patient years. […] There are no reported disparities in incidents based on gender.

• #2 Hypoglycemia epidemiology and demographics – wikidoc

  https://www.wikidoc.org/index.php/Hypoglycemia_epidemiology_and_demographics

  Event rate for severe hypoglycemia ranges from 40 to 100 percent of patients with type 1 diabetes. […] Frequency of hypoglycemia in patients with type 2 diabetes is the same as type 1 diabetes, as insulin deficiency occurs at the end in DM type 2 and require aggressive treatment with insulin. […] Hypoglycemia is uncommon in individuals who do not have drug-treated diabetes mellitus. […] Hypoglycemia commonly affects patients with type 2 diabetes. So, the risk of severe hypoglycemia is low in the first few years (7%) and that risk increases to 25% later in the course of diabetes according to the UK Hypoglycemia Study. […] There is no gender predilection of hypoglycemia. […] There is no racial predilection of hypoglycemia.

• #2 Hypoglycaemia in diabetes mellitus: epidemiology and clinical implications | Nature Reviews Endocrinology

  https://www.nature.com/articles/nrendo.2014.170

  Hypoglycaemia, a common adverse effect of treatment of diabetes mellitus with insulin and sulphonylureas, is associated with impairment of cognitive function, which can have important consequences on everyday behaviour. […] Adults with type 1 diabetes mellitus have 2 episodes of mild hypoglycaemia per week; the annual prevalence of severe hypoglycaemia is 30%, with several factors, such as long disease duration, increasing its incidence. […] Adults with insulin-treated type 2 diabetes mellitus experience a lower frequency of mild and severe hypoglycaemia episodes than those with type 1 diabetes mellitus, but frequency rises progressively with increasing duration of insulin therapy. […] Prevention of hypoglycaemia is an important part of diabetes mellitus management and strategies include patient education, glucose monitoring, appropriate adjustment of diet and medications in relation to everyday circumstances including physical exercise, and the application of new technologies such as real-time continuous glucose monitoring, modified insulin pumps and the artificial pancreas.

• #2 SciELO Brazil – Epidemiology and risk factors of hypoglycemia in subjects with type 1 diabetes in Brazil: a cross-sectional, multicenter study Epidemiology and risk factors of hypoglycemia in subjects with type 1 diabetes in Brazil: a cross-sectional, mu

  https://www.scielo.br/j/aem/a/xvr6YvDN4CWjHQQTG6jvYBP/

  Of 1,760 individuals evaluated, 1,319 (74.9%) reported at least one episode of hypoglycemia in the previous 4 weeks. […] Severe hypoglycemia (SH), defined as an event requiring third-party assistance, occurs in approximately 30% of the individuals with T1D and is an important cause of morbidity. […] Despite the vast literature about the pathophysiological mechanisms of diabetes-related hypoglycemia, real-world data on the clinical incidence and predisposing clinical and social factors associated with this complication are scant, especially in developing countries. […] The percentage of SH episodes was evenly distributed across all ranges of HbA1c levels, and there were no correlations between the mean number of nonsevere or severe hypoglycemic events and HbA1c values. […] Higher alcohol consumption and more frequent hospitalizations were independently associated with SH.

• #2 Epidemiology of hypoglycemia among ambulatory – ProQuest

  https://www.proquest.com/scholarly-journals/epidemiology-hypoglycemia-among-ambulatory-type-2/docview/2089044574/se-2

  Aim: The study was aimed at describing the epidemiology of hypoglycemia among ambulatory type 2 diabetic patients in a primary care clinic in Eastern Nigeria. […] The prevalence of hypoglycemia was 35.2%. Hypoglycemia occurred predominantly among the elderly (72.5%), male gender (54.9%), outside home environment (72.5%), during the daytime (82.4%), duration of diabetes 1 year (58.8%), and patients on insulin secretagogues alone (46.2%). […] Experience of hypoglycemia was significantly associated with elderly age (P = 0.025), duration of diabetes 1 year (P = 0.021), and use of insulin secretagogues alone (P = 0.043). […] The most significant predictor of hypoglycemic events was use of insulin and insulin secretagogues (odds ratio = 3.15 [1.745.66]; P = 0.002). Type 2 diabetic patients on insulin and insulin secretagogues were three times more likely to experience hypoglycemic events compared to their counterparts who were on insulin sensitizers.

• #2 Severe Hypoglycemia Linked to Increased Risk of Death in People With Diabetes | Johns Hopkins | Bloomberg School of Public Health

  https://publichealth.jhu.edu/2017/severe-hypoglycemia-linked-to-increased-risk-of-death-in-people-with-diabetes

  One to two per 100 people with diabetes per year experience severe hypoglycemia ending in a hospital visit, Lee says. […] They found that 192 experienced hypoglycemia that led to an emergency room visit or hospitalization. Those people were nearly twice as likely to die of any cause than those people with diabetes who did not have severe hypoglycemia. […] Researchers say that past studies have shown that people who experience severe hypoglycemia experience low-level heart damage, so a biological link between hypoglycemia and death from cardiovascular disease could be an extension of that. […] If diabetes medications are used improperly, blood sugar can get dangerously low.

• #2

  https://journals.lww.com/jhrr/fulltext/2018/05020/epidemiology_of_hypoglycemia_among_ambulatory_type.1.aspx

  The findings of this study therefore brings to the fore, the issue of the clinicoepidemiological variables that predispose diabetes patients to hypoglycemia. […] The most significant predictor of experience of hypoglycemic event was the use of insulin and insulin secretagogues (OR = 3.15; confidence interval = 1.745.66; P = 0.002). […] This study has demonstrated the variabilities in the occurrence of hypoglycemia among diabetes patients on commonly used antidiabetic medications in Nigeria.

• #2

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6117835/

  Hypoglycemia is the most common and often treatment-limiting serious adverse effect of diabetes therapy. […] We review the epidemiology of hypoglycemia in type 2 diabetes, discuss key risk factors, and introduce potential prevention strategies. […] Reported rates of hypoglycemia in type 2 diabetes vary widely as there is marked heterogeneity in how hypoglycemia is defined, measured, and reported. […] Hypoglycemia is most common among older patients with multiple or advanced comorbidities, patients with long diabetes duration, or patients with a prior history of hypoglycemia. […] Clinical decision support tools may help identify at-risk patients. […] Prospective trials of efforts to reduce hypoglycemia risk are needed, and there is emerging evidence supporting multidisciplinary interventions including treatment deintensification, diabetes self-management, and social support.

• #2 Hypoglycemia (Low Blood Sugar): Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/11647-hypoglycemia-low-blood-sugar

  Hypoglycemia is common in people with diabetes, especially people who take insulin to manage the condition. […] One study found that 4 in 5 people with Type 1 diabetes and nearly half of all people with Type 2 diabetes who take insulin reported a low blood sugar episode at least once over a four-week period. […] People with Type 2 diabetes who take meglitinide or sulfonylurea oral diabetes medications are also at an increased risk for low blood sugar. […] Hypoglycemia happens when your blood sugar drops below a healthy range. Several factors can contribute to this for people with diabetes. Hypoglycemia can develop if things like food, exercise and diabetes medications are out of balance. […] Prolonged severe hypoglycemia is life-threatening and can lead to multiple organ failure, cardiac arrhythmias, cardiac arrest, permanent brain damage, coma, and death. […] The prognosis (outlook) of non-diabetes-related hypoglycemia varies depending on the underlying cause. […] Having frequent hypoglycemia episodes can be dangerous if you have diabetes. It can lead to hypoglycemia unawareness, which means you dont experience warning signs of low blood sugar.

• #2 Prevalence and predictors of hypoglycemia in older outpatients with type 2 diabetes mellitus | PLOS One

  https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0309618

  Current study identified a considerable prevalence of hypoglycemia among older patients with type 2 diabetes, particularly, among those with concurrent liver diseases and dyslipidemia. Furthermore, hypoglycemia was associated with an increased rate of emergency department visits and hospital admissions by 2 folds in this population. […] Results of the current study estimated that prevalence of hypoglycemia among elderly patients was 21.7%. […] Hypoglycemia is generally associated with severe negative consequences including increased risk of cardiac arrhythmias, falls, and even mortality. […] The presence of chronic comorbidities including liver conditions and dyslipidemia were linked to an increase in the risk of hypoglycemic events in this study. […] Patients who had developed hypoglycemia were more subjected to emergency department visits and hospital admissions.

• #2 Impaired hypoglycemia awareness in diabetes: epidemiology, mechanisms and therapeutic approaches | Klimontov | Diabetes mellitus

  https://www.dia-endojournals.ru/jour/article/view/9597/en_US?locale=en_US

  Impaired awareness of hypoglycemia (IAH) is a frequent complication of insulin therapy. Up to half insulin-treated individuals with type 1 and type 2 diabetes report the problems with hypoglycemia awareness, and 15-25% of patients have a permanent IAH. […] A growing body of evidence indicates that IAH is a reversible condition. If the syndrome is present, the hypoglycemia avoidance should be primary goal of the treatment. […] The diabetes management in patients with IAH is time-consuming and expensive. Therefore, step-by-step approach, from insulin personalization and therapeutic training to advanced medical technologies, should be recommended for these patients.

• #2 Food insecurity doubles rate of severe hypoglycemia in diabetic adults: Study  

  https://news.westernu.ca/2023/10/food-insecurity-doubles-rate-of-severe-hypoglycemia-in-diabetic-adults-study/

  Adults living with diabetes who can’t afford to put food on the table are at more than twice the risk of severe hypoglycemia. […] Severe hypoglycemia was 2.3 times as frequent in people taking insulin and/or secretagogues who reduced or skipped meals altogether compared to those not exposed to food insecurity. […] While food insecurity is known to impact health, its effect on level 3 hypoglycemia is unquantified in the U.S., said Ratzki-Leewing. […] We have shown that food insecurity is prevalent across this population in the U.S. and it more than doubles the rate of severe hypoglycemia. […] The impact of the pandemic on the results is not clear, said Ratzki-Leewing, “but at the very least, we know that food insecurity can have a lasting effect on severe hypoglycemia rates even in the aftermath of the pandemic.” […] Ratzki-Leewing called for more research into these issues to better understand the population health impact of food insecurity.

• #2 Temporal changes in frequency of severe hypoglycemia treated by emergency medical services in types 1 and 2 diabetes: a population-based data-linkage cohort study | Cardiovascular Diabetology – Endocrinology Reports | Full Text

  https://clindiabetesendo.biomedcentral.com/articles/10.1186/s40842-017-0045-0

  The present study aimed to re-measure the incidence rates of severe hypoglycemia in types 1 and 2 diabetes that had required emergency medical services in the same region of Tayside over the period 1 January 2011 to 31 December 2012, and by comparison with the incidence rates documented in 1997-1998, to ascertain whether these had changed significantly over time. […] The present population-based, data-linkage study within a single region of Scotland has demonstrated that a lower incidence rate of severe hypoglycemia had required treatment by emergency medical services compared to the frequency observed 14 years earlier. […] While the incidence rate of severe hypoglycemia in people with type 1 diabetes had declined by about 30%, a more prominent fall was observed in people with insulin-treated type 2 diabetes, which was almost 70% lower.

• #2 Diabetes Canada | Clinical Practice Guidelines

  https://guidelines.diabetes.ca/cpg/chapter14

  Frequent hypoglycemia can decrease normal responses to hypoglycemia (12) and lead to defective glucose counter-regulation and hypoglycemia unawareness. Hypoglycemia unawareness occurs when the threshold for the development of autonomic warning symptoms is close to, or lower than, the threshold for the neuroglycopenic symptoms, such that the first sign of hypoglycemia is confusion or loss of consciousness. Severe hypoglycemia is often the primary barrier to achieving glycemic targets in people with type 1 diabetes (24) and occurs frequently during sleep or in the presence of hypoglycemia unawareness (11,25). […] Structured educational and psycho-behavioural programs (e.g. BG awareness training) may help improve detection of hypoglycemia and reduce the frequency of severe hypoglycemia (4043). People with diabetes who continue to have frequent and severe hypoglycemia and/or impaired awareness of hypoglycemia, despite educational interventions, may benefit from continuous subcutaneous insulin infusion (CSII) therapy or continuous glucose monitoring (CGM) or both (i.e. a sensor augmented pump), to reduce the risk of severe hypoglycemia (4447).

• #2 Hypoglycaemia (Causes, Symptoms, and Treatment)

  https://patient.info/doctor/hypoglycaemia

  Hypoglycaemia epidemiology is uncommon in people without diabetes. […] Hypoglycaemia adversely affects quality of life in patients with diabetes. […] Studies have also suggested that hypoglycaemia is associated with an increased risk of cardiovascular events and mortality. […] Severe hypoglycaemia is estimated to be associated with an increased future mortality risk of 50-60%.

• #2

  https://link.springer.com/article/10.1007/s11892-018-1018-0

  Hypoglycemia is most common among older patients with multiple or advanced comorbidities, patients with long diabetes duration, or patients with a prior history of hypoglycemia. Insulin and sulfonylurea use, food insecurity, and fasting also increase hypoglycemia risk. […] Prospective trials of efforts to reduce hypoglycemia risk are needed, and there is emerging evidence supporting multidisciplinary interventions including treatment de-intensification, use of diabetes technologies, diabetes self-management, and social support. […] Hypoglycemia among patients with type 2 diabetes is common. Patient-centered multidisciplinary care may help proactively identify at-risk patients and address the multiplicity of factors contributing to hypoglycemia occurrence. […] This study demonstrated that only 5% of severe hypoglycemic events experienced by patients with diabetes culminate in an emergency department visit or hospitalization event.

• #3 Hypoglycemia – Wikipedia

  https://en.wikipedia.org/wiki/Hypoglycemia

  Hypoglycemia is common in people with type 1 diabetes, and in people with type 2 diabetes taking insulin, glinides, or sulfonylurea. It is estimated that type 1 diabetics experience two mild, symptomatic episodes of hypoglycemia per week. Additionally, people with type 1 diabetes have at least one severe hypoglycemic episode per year, requiring treatment assistance. In terms of mortality, hypoglycemia causes death in 6-10% of type 1 diabetics. […] In those with type 2 diabetes, hypoglycemia is less common compared to type 1 diabetics, because medications that treat type 2 diabetes like metformin, glitazones, alpha-glucosidase inhibitors, glucagon-like peptide 1 agonists, and dipeptidyl peptidase IV inhibitors, do not cause hypoglycemia. Hypoglycemia is common in type 2 diabetics who take insulin, glinides, or sulfonylurea. Insulin use remains a key risk factor in developing hypoglycemia, regardless of diabetes type.

• #3 Hypoglycemia epidemiology and demographics – wikidoc

  https://www.wikidoc.org/index.php/Hypoglycemia_epidemiology_and_demographics

  Patients with type 1 diabetes may suffer an average of two episodes of symptomatic hypoglycemia per week, thousands of such episodes over a lifetime of diabetes, and one episode of severe symptoms per year. […] Hypoglycemia is less frequent in type 2 diabetes than it is in type1. […] Worldwide, the incidence of severe hypoglycemia event was 4800 per 100.000 patient per year and of moderate events was 13100 per 100.000 patient per year. […] Rates of hypoglycemia were increased in children 6 years of age. […] Patients with type 1 diabetes may have increased frequency of symptomatic hypoglycemia which may include one severe episode per year. […] Hypoglycemia is less frequent in type 2 diabetes than it is in type1. […] Event rate for severe hypoglycemia in insulin-treated type 2 diabetes is approximately 30% of that in type 1.

Zobacz więcej