Hypoglycaemia in type 2 diabetes mellitus – a brief overview for clinical practice


Authors: J. Brož 1;  J. Urbanová 2
Authors‘ workplace: Univerzita Karlova v Praze ;  2. lékařská fakulta Interní klinika 2. LF UK a FN Motol Přednosta: prof. MUDr. Milan Kvapil, CSc., MBA 1;  3. lékařská fakulta Centrum pro výzkum diabetu, metabolismu a výživy II. interní klinika 3. LF UK a FNKV Přednosta: prof. MUDr. Michal Kršek, CSc. 2
Published in: Prakt. Lék. 2019; 99(2): 52-56
Category: Reviews

Overview

Hypoglycaemia is a consistent risk of the type 2 diabetes (T2DM) therapy, especially insulin or some older oral hypoglycaemic agents as the insulin secretagogues. It is also associated with various range of health disorders, increased cardiovascular risk or death. Hypoglycaemia can present with diverse symptoms or can be asymptomatic. Almost 10% of patients with T2DM suffer from hypoglycaemia unawareness. The risk of hypoglycaemia is associated with a level of glycaemic control and increases also with age, comorbidities and strength of diabetes therapy. Warning value, in which patients with diabetes should considered initiation of appropriate therapeutic steps, is the level of glycaemia 3.9 mmol/l.

Keywords:

impaired hypoglycaemia awarness


Sources

1. International Hypoglycaemia Study Group. Glucose concentrations of less than 3.0 mmol/L (54 mg/dL) should be reported in clinical trials: a joint position statement of the American Diabetes Association and the European Association for the Study of Diabetes. Diabetes Care 2017; 40(1): 155–157.

2. International Hypoglycemia Study Group: Minimizing hypoglycemia in diabetes. Diabetes Care 2015; 38: 1583–1591.

3. Rizza RA, Cryer PE, Gerich JE. Role of glucagon, catecholamines, and growth hormone in human glucose counterregulation. Effects of somatostatin and combined alpha- and beta-adrenergic blockade on plasma glucose recovery and glucose flux rates after insulin-induced hypoglycemia. J Clin Invest 1979; 64: 62–71.

4. McAulay V, Deary IJ, Frier BM. Symptoms of hypoglycaemia in people with diabetes. Diabet Med 2001; 18: 690–705.

5. de Galan BE, Schouwenberg BJ, Tack CJ, et al. Pathophysiology and management of recurrent hypoglycaemia and hypoglycaemia unawareness in diabetes. Neth J Med 2006; 64: 269–279.

6. Moghissi E, Ismail-Beigi F, Devine RC. Hypoglycemia: minimizing its impact in type 2 diabetes. Endocr Pract 2013; 19: 526–535.

7. Gerstein HC, Miller ME, Byington RP, et al. Effects of intensive glucose lowering in type 2 diabetes. N Engl J Med 2008; 358: 2545–2559.

8. Cryer PE. The barrier of hypoglycemia in diabetes. Diabetes 2008; 57: 3169–3176.

9. Martín-Timón I, del Cañizo-Gómez FJ. Mechanisms of hypoglycemia unawareness and implications in diabetic patients. World J Diabetes 2015; 6: 912–926.

10. Gold AE, MacLeod KM, Frier BM. Frequency of severe hypoglycemia in patients with type 1 diabetes and impaired awareness of hypoglycemia. Diabetes Care 1994; 17: 697–703.

11. McCoy RG, Van Houten HK. Increased mortality of patients with diabetes reporting severe hypoglycemia. Diabetes Care 2012; 35: 1897–1900.

12. Hemmingsen B, Lund SS, Gluud C, et al. Intensive glycaemic control for patients with type 2 diabetes: systematic review with meta-analysis and trial sequential analysis of randomised clinical trials. BMJ 2011; 343: d6898.

13. Bolek T, Samoš M, Mokáň M, a kol. Akútne príčiny náhlych úmrtí u pacientov so závažnou hypoglykemiou. Vnitř. Lek. 2016; 62: 462–466.

14. Lee AK, Warren B, Lee CJ, et al. Association of severe hypoglycemia with cardiovascular disease and all-cause mortality in older adults with diabetes: the atherosclerosis risk in communities (ARIC) study. Circulation 2017; 135: A4.

15. Marrett E, Radican L, Davies MJ, Zhang Q. Assessment of severity and frequency of self-reported hypoglycemia on quality of life in patients with type 2 diabetes treated with oral antihyperglycemic agents: a survey study. BMC Res Notes 2011; 4(1): 251.

16. McCoy R, Van Houten H, Ziegenfuss J, et al. Self-report of hypoglycemia and health-related quality of life in patients with type 1 and type 2 diabetes. Endocr Pract 2013; 19(5): 792–799.

17. Action to Control Cardiovascular Risk in Diabetes Study G, Gerstein HC, Miller ME, Byington RP, et al. Effects of intensive glucose lowering in type 2 diabetes. N Engl J Med 2008; 358(24): 2545–2559.

18. Aroup AC, Patel A, MacMahon S, et al. Intensive blood glucose control and vascular outcomes in patients with type 2 diabetes. N Engl J Med 2008; 358(24): 2560–2572.

19. Duckworth W, Abraira C, Moritz T, et al. Glucose control and vascular complications in veterans with type 2 diabetes. N Engl J Med 2009; 360(2): 129–139.

20. Zoungas S, Patel A, Chalmers J, et al. Severe hypoglycemia and risks of vascular events and death. N Engl J Med 2010; 363(15): 1410–1418.

21. Bonds DE, Miller ME, Bergenstal RM, et al. The association between symptomatic, severe hypoglycaemia and mortality in type 2 diabetes: retrospective epidemiological analysis of the ACCORD study. BMJ 2010; 340: b4909.

22. UK Prospective Diabetes Study (UKPDS) group. Intensive blood glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). Lancet 1998; 352: 837–843.

23. Wright AD, Cull CA, Macleod KM, et al. Hypoglycemia in type 2 diabetic patients randomized to and maintained on monotherapy with diet, sulfonylurea, metformin, or insulin for 6 years from diagnosis: UKPDS73. J Diabetes Complicat 2006; 20(6): 395–401.

24. Misra-Hebert AD, Pantalone KM, Ji X, et al. Patient characteristics associated with severe hypoglycemia in a type 2 diabetes cohort in a large, integrated health care system from 2006 to 2015. Diabetes Care 2018; 41(6): 1164–1171.

25. Davis TM, Brown SG, Jacobs IG, et al. Determinants of severe hypoglycemia complicating type 2 diabetes: the Fremantle Diabetes Study. J Clin Endocrinol Metab 2010; 95(5): 2240–2247.

26. Quilliam BJ, Simeone JC, Ozbay AB. Risk factors for hypoglycemia-related hospitalization in patients with type 2 diabetes: a nested case-control study. Clin Ther 2011; 33(11): 1781–1791.

27. Misra-Hebert AD, Pantalone KM, Ji X, et al. Patient characteristics associated with severe hypoglycemia in a type 2 diabetes cohort in a large, integrated health care system from 2006 to 2015. Diabetes Care 2018; 41(6): 1164–1171.

28. Davis TM, Brown SG, Jacobs IG, et al. Determinants of severe hypoglycemia complicating type 2 diabetes: the Fremantle Diabetes Study. J Clin Endocrinol Metab 2010; 95(5): 2240–2247.

29. Investigators OT. Predictors of nonsevere and severe hypoglycemia during glucose-lowering treatment with insulin glargine or standard drugs in the ORIGIN trial. Diabetes Care 2015; 38(1): 22–28.

30. Rosenstock J, Dailey G, Massi-Benedetti M, et al. Reduced hypoglycaemia risk with insulin glargine: a meta-analysis comparing insulin glargine with human NPH insulin in type 2 diabetes. Diabetes Care 2005; 28: 950–955.

31. Horvath K, Jeitler K, Berghold A, et al. Long-acting insulin analogues versus NPH insulin (human isophane insulin) for type 2 diabetes mellitus. Cochrane Database Syst Rev 2007; 2: CD 005613.

32. Monami M, Marchionni N, Mannucci E. Long-acting insulin analogues versus NPH human insulin in type 2 diabetes. A meta-analysis. Diabetes Res Clin Pract 2008; 81: 184–189.

33. Roussel R, Ritzel R, Boëlle-Le Corfec E, et al. Clinical perspectives from the BEGIN and EDITION programmes: Trial-level meta-analyses outcomes with either degludec or glargine 300 U/ml vs glargine 100 U/ml in T2DM. Diabetes Metab 2018; 44(5): 402–409.

34. Zinman B, Philis-Tsimikas A, Cariou B, et al. Insulin degludec versus insulin glargine in insulin-naive patients with type 2 diabetes: a 1-year, randomized, treat-to-target trial (BEGIN Once Long). Diabetes Care 2012; 35: 2464–2471.

35. Ritzel R, Roussel R, Giaccari A, et al. Better glycaemic control and less hypoglycaemia with insulin glargine 300 U/mL vs glargine 100 U/mL: 1-year patient-level meta-analysis of the EDITION clinical studies in people with type 2 diabetes. Diabetes Obes Metab 2018; 20: 541–548.

36. Ritzel R, Roussel R, Bolli GB, et al. Patient-level meta-analysis of the EDITION 1, 2 and 3 studies: glycaemic control and hypoglycaemia with new insulin glargine 300 U/ml versus glargine 100 U/ml in people with type 2 diabetes. Diabetes Obes Metab 2015; 17: 859–867.

37. Mauricio D, Hramiak I. Second-generation insulin analogues – a review of recent real-world data and forthcoming head-to-head comparisons. Eur Endocrinol 2018; 14(Suppl1): 2–9.

38. Evans Kreider K, Pereira K, Padilla BI. Practical approaches to diagnosing, treating and preventing hypoglycemia in diabetes. Diabetes Ther 2017; 8: 1427–1435.

39. McCoy RG, Lipska KJ, Yao X, et al. Intensive treatment and severe hypoglycemia among adults with type 2 diabetes mellitus: a population-based study. JAMA Intern Med 2016; 176(7): 969–978.

40. Lipska KJ, Warton EM, Huang ES, et al. HbA1c and risk of severe hypoglycemia in type 2 diabetes: the Diabetes and Aging Study. Diabetes Care 2013; 36(11): 3535–3542.

41. Mathur S, Zammitt NN, Frier BM. Optimal glycaemic control in elderly people with type 2 diabetes: what does the evidence say? Drug Saf 2015; 38(1): 17–32.

42. Frier BM. Hypoglycaemia in diabetes mellitus: epidemiology and clinical implications. Nat Rev Endocrinol 2014; 10: 711–722.

43. Villani M, de Courten B, Zoungas S. Emergency treatment of hypoglycaemia: a guideline and evidence review. Diabet Med 2017; 34(9): 1205–1211.

Labels
General practitioner for children and adolescents General practitioner for adults
Login
Forgotten password

Don‘t have an account?  Create new account

Forgotten password

Enter the email address that you registered with. We will send you instructions on how to set a new password.

Login

Don‘t have an account?  Create new account