B Cariou1, P Fontaine2, E Eschwege3, M Lièvre4, D Gouet5, D Huet6, S Madani7, S Lavigne8, B Charbonnel9. 1. Department of Endocrinology, l'institut du Thorax, CHU de Nantes, hôpital Guillaume & René Laennec, boulevard Jacques-Monod, 44093 Nantes cedex 1, France. Electronic address: bertrand.cariou@univ-nantes.fr. 2. Department of Endocrinology and Diabetology, University Hospital of Lille, Lille, France. 3. Inserm U-1018, Centre de Recherche en Epidémiologie et Santé des populations (CESP), Villejuif, France. 4. Laennec Faculty of Medicine, Lyon, France. 5. Hôpital Saint-Louis, centre hospitalier de La Rochelle, La Rochelle, France. 6. Hôpital Saint-Joseph, Paris, France. 7. Novo Nordisk, Paris, France. 8. ITEC Services SAS, Cenon, France. 9. Department of Endocrinology, l'institut du Thorax, CHU de Nantes, hôpital Guillaume & René Laennec, boulevard Jacques-Monod, 44093 Nantes cedex 1, France.
Abstract
AIM: DIALOG assessed the prevalence and predictors of hypoglycaemia in patients with type 1 (T1DM) or insulin-treated type 2 diabetes mellitus (T2DM) in a real-life setting. METHODS: In this observational study, insulin-treated patients (n=3048) completed prospective daily questionnaires reporting the frequency and consequences of severe/confirmed non-severe hypoglycaemia over 30 days. Patients (n=3743) also retrospectively reported severe hypoglycaemia over the preceding year. RESULTS: In this prospective survey, 85.3% and 43.6% of patients with T1DM and T2DM, respectively, reported experiencing at least one confirmed hypoglycaemic event over 30 days, while 13.4% and 6.4%, respectively, reported at least one severe event. Hypoglycaemia frequency increased with longer duration of diabetes and insulin therapy. Strongly predictive factors for hypoglycaemia were previous hypoglycaemia, >2 injections/day, BMI<30kg/m(2) and duration of insulin therapy>10 years. HbA1c level was not predictive of hypoglycaemia in either T1DM or T2DM. The confirmed hypoglycaemia rate was increased in the lowest compared with the highest tertile of HbA1c in T1DM, but not T2DM. At the time of enrolment, physicians reported severe hypoglycaemia in 23.6% and 11.9% of T1DM and T2DM patients, respectively, during the preceding year; the retrospective survey yielded frequencies of 31.5% and 21.7%, respectively. Also, severe hypoglycaemia led to medical complications in 10.7% and 7.8% of events in T1DM and T2DM patients, respectively, over 30 days. CONCLUSION: Using a unique combined prospective and retrospective approach, the DIALOG study found a relatively high frequency of hypoglycaemia among insulin-treated patients. These findings emphasize the importance of a patient-centred approach for managing diabetes in which hypoglycaemia risk evaluation is critical. TRIAL REGISTRATION: ClinicalTrials.gov: NCT01628341.
AIM: DIALOG assessed the prevalence and predictors of hypoglycaemia in patients with type 1 (T1DM) or insulin-treated type 2 diabetes mellitus (T2DM) in a real-life setting. METHODS: In this observational study, insulin-treatedpatients (n=3048) completed prospective daily questionnaires reporting the frequency and consequences of severe/confirmed non-severe hypoglycaemia over 30 days. Patients (n=3743) also retrospectively reported severe hypoglycaemia over the preceding year. RESULTS: In this prospective survey, 85.3% and 43.6% of patients with T1DM and T2DM, respectively, reported experiencing at least one confirmed hypoglycaemic event over 30 days, while 13.4% and 6.4%, respectively, reported at least one severe event. Hypoglycaemia frequency increased with longer duration of diabetes and insulin therapy. Strongly predictive factors for hypoglycaemia were previous hypoglycaemia, >2 injections/day, BMI<30kg/m(2) and duration of insulin therapy>10 years. HbA1c level was not predictive of hypoglycaemia in either T1DM or T2DM. The confirmed hypoglycaemia rate was increased in the lowest compared with the highest tertile of HbA1c in T1DM, but not T2DM. At the time of enrolment, physicians reported severe hypoglycaemia in 23.6% and 11.9% of T1DM and T2DM patients, respectively, during the preceding year; the retrospective survey yielded frequencies of 31.5% and 21.7%, respectively. Also, severe hypoglycaemia led to medical complications in 10.7% and 7.8% of events in T1DM and T2DM patients, respectively, over 30 days. CONCLUSION: Using a unique combined prospective and retrospective approach, the DIALOG study found a relatively high frequency of hypoglycaemia among insulin-treatedpatients. These findings emphasize the importance of a patient-centred approach for managing diabetes in which hypoglycaemia risk evaluation is critical. TRIAL REGISTRATION: ClinicalTrials.gov: NCT01628341.
Authors: Aveni Haynes; Julia M Hermann; Kellee M Miller; Sabine E Hofer; Timothy W Jones; Roy W Beck; David M Maahs; Elizabeth A Davis; Reinhard W Holl Journal: Pediatr Diabetes Date: 2016-11-23 Impact factor: 4.866
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