Home P, et al. - Factors associated with documented symptomatic and severe hypoglycaemia over 4 years, were identified, in people with type 2 diabetes starting insulin therapy. Despite increased insulin doses, hypoglycaemia occurred at significant rates but was stable over 4 years. Over that time, the association with insulin regimen and with oral agent use declined. Associated predictor and explanatory variables for documented symptomatic hypoglycaemia conformed to clinical impressions. It could be extended to severe hypoglycaemia. Better achieved HbA1c was correlated with a higher risk of hypoglycaemia.

Methods

• CREDIT, a prospective international observational study, collected data over 4 years on people starting any insulin in 314 centers.
• This study included 2,729 and 2,271 people who had hypoglycaemia data during the last 6 months of years 1 and 4.
• The physicians used multivariable logistic regression to select characteristics associated with documented symptomatic hypoglycaemia, and the model tested against severe hypoglycaemia.

Results

• In years 1 and 4, participants reporting ≥1 non-severe event were 18.5% and 16.6%.
• It was found to be 24.6% and 18.3% in those achieving an HbA1c <7.0% (<53 mmol/mol), and 16.5% and 16.2% if not.
• For severe hypoglycaemia, this was 3.0% and 4.6% of people reaching target vs 1.5% and 1.1%.
• In multivariable analysis, baseline lower body mass index and more physical activity were predictors, and lower HbA1c was an explanatory variable in that year, for documented symptomatic hypoglycaemia at both year 1 and year 4.
• Severe hypoglycaemia was predicted by models for documented symptomatic hypoglycaemia.
• Insulin regimen was a univariate explanatory variable, which was not retained on multivariable analysis.