Abstract
BackgroundHypoglycaemic events, particularly nocturnal, affect health-related quality of life (HRQoL) via acute symptoms, altered behaviour and fear of future events. We examined the respective disutility associated with a single event of daytime, nocturnal, severe and non-severe hypoglycaemia.MethodsRepresentative samples were taken from Canada, Germany, Sweden, the United States and the United Kingdom. Individuals completed an internet-based questionnaire designed to quantify the HRQoL associated with different diabetes- and/or hypoglycaemia-related health states. HRQoL was measured on a utility scale: 1 (perfect health) to 0 (death) using the time trade-off method. Three populations were studied: 8286 respondents from the general population; 551 people with type 1 diabetes; and 1603 with type 2 diabetes. Respondents traded life expectancy for improved health states and evaluated the health states of well-controlled diabetes and diabetes with non-severe/severe and daytime/nocturnal hypoglycaemic events.ResultsIn the general population, non-severe nocturnal hypoglycaemic events were associated with a 0.007 disutility compared with 0.004 for non-severe daytime episodes, equivalent to a significant 63% increase in negative impact. Severe daytime and nocturnal events were associated with a 0.057 and a 0.062 disutility, respectively, which were not significantly different.ConclusionsThis study applies an established health economic methodology to derive disutilities associated with hypoglycaemia stratified by onset time and severity using a large multinational population. It reveals substantial individual and cumulative detrimental effects of hypoglycaemic events – particularly nocturnal – on HRQoL, reinforcing the clinical imperative of avoiding hypoglycaemia.
Highlights
Hypoglycaemic events, nocturnal, affect health-related quality of life (HRQoL) via acute symptoms, altered behaviour and fear of future events
Hypoglycaemia is defined as a deficiency of glucose in the bloodstream causing neuroglycopenic and autonomic symptoms, and is a well-recognized side effect in the insulin-based management of both type 1 and type 2 diabetes, with a reported overall incidence of 42.9 events per patient-year for type 1 diabetes and 16.4 events per patient-year for type 2 diabetes [1]
Repeated events can lead to impaired hypoglycaemia awareness, a condition affecting 20–25% of patients with type 1 diabetes and up to 10% of patients with type 2 diabetes, which raises the risk of severe hypoglycaemia and associated morbidity by up to sixfold [11]
Summary
Hypoglycaemic events, nocturnal, affect health-related quality of life (HRQoL) via acute symptoms, altered behaviour and fear of future events. Hypoglycaemia can impact patient health-related quality of life (HRQoL) in two ways: firstly, through the direct physiological effects of repeated episodes; and secondly, through fear of future hypoglycaemia, leading to the adoption of avoidant, precautionary or compensatory actions (e.g., restricting holiday choices, avoiding physical exertion, defensive eating, insufficient insulin dosing) [7,8,9,10]. Repeated events can lead to impaired hypoglycaemia awareness, a condition affecting 20–25% of patients with type 1 diabetes and up to 10% of patients with type 2 diabetes, which raises the risk of severe hypoglycaemia and associated morbidity by up to sixfold [11]
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