Abstract
The aim of this study was to evaluate the frequency of hypoglycemia and the treatment satisfaction in patients with type 1 diabetes (T1D) using insulin analogues. This observational retrospective study included 516 adult patients with T1D from 38 cities in Southern Brazil. Demographics and clinical data were collected using a self-report questionnaire. Hypoglycemia was defined as an event based on either symptoms or self-monitored blood glucose < 70 mg/dL. Treatment satisfaction was evaluated using the Diabetes Treatment Satisfaction Questionnaire status version (DTSQs) and with a specific question with scores ranging from 0-10. Common mental disorders were assessed using the General Health Questionnaire (GHQ-12). Overall, the mean age was 38 ± 14 years and 52% of the participants were women. The median diabetes duration was 18 years. The scores for insulin analogue treatment satisfaction were higher than those for previous treatments. DTSQ scores had a median value of 32 (interquartile range 29-35) and remained unchanged over time. The percentage of patients with hypoglycemia (including severe and nocturnal) was comparable across groups divided according to duration of use of insulin analogues. Most patients (n=395, 77%) screened positive for common mental disorders. Patient satisfaction with insulin analogue treatment was high and remained unchanged with time. Episodes of hypoglycemia also remained unchanged over time among patients using insulin analogues.
Highlights
Type 1 diabetes mellitus is a chronic and progressive disease with an increasing incidence over the past decades
The use of insulin analogues reduces such events and increases patient adherence and satisfaction [19]. In this pioneering study evaluating the satisfaction of patients with type 1 diabetes mellitus receiving insulin analogues determined by a pre-established procedure in Southern Brazil, we found a high incidence of severe hypoglycemia and greater treatment satisfaction in patients using insulin analogues compared with treatment satisfaction in the prior period when they received human insulin
25% of the patients in the Hypoglycemia Assessment Tool (HAT) study in Brazil had severe hypoglycemia, which was comparable to our data (22%), while 54% of the patients had nocturnal hypoglycemia, which was higher than the rate found in our study (41%) [22]
Summary
Type 1 diabetes mellitus is a chronic and progressive disease with an increasing incidence over the past decades. Estimates project that 5–10% of all 12 million patients with diabetes in Brazil have type 1 diabetes [1]. The increased morbidity and mortality due to microvascular and macrovascular complications related to this disease result in reduced quality of life and life expectancy [2,3]. The Diabetes Control and Complications Trial (DCCT) has shown that strict glycemic control in patients with diabetes significantly decreases the risk of. Treatment satisfaction and insulin analogues chronic complications [4]. Multiple-dose insulin or insulin pumps have become the recommended treatment for these patients. Achieving the recommended reduction in glycated hemoglobin (HbA1c) levels is very difficult due to multiple factors, including a high frequency of hypoglycemia [4,5,6]
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