Prevalence Of Hypoglycemia Research Articles

A retrospective analysis of dysglycaemia and its risk factors in a cohort of human immunodeficiency virus infected antiretroviral therapy naïve children in Makurdi, Nigeria

Background: Human immunodeficiency virus (HIV) endocrinopathy involving the pancreas manifests clinically as dysglycaemia, including hypoglycaemia and hyperglycaemia. Dysglycaemia increases mortality in sick children, underlying the need for its evaluation and management. Objective: To assess the prevalence and risk factors of dysglycaemia in a cohort of antiretroviral therapy (ART)-naive children at the point of enrolment into a paediatric ART clinic of the Federal Medical Centre, Makurdi, Nigeria. Method: A retrospective cross-sectional study was carried out between June 2010 and June 2012. Hypoglycaemia was defined as random blood glucose level ˂2.2 mmol/l and hyperglycaemia as random blood glucose ˃6.6 mmol/l. Potential risk factors of dysglycaemia were tested for significance in bivariate and multivariate regression analyses. P -value less than 0.05 was considered to be significant. Results: 429 children, aged 1-15 years, including 223 males and 206 females were studied. The median age was 5 years. Twelve (2.8%) children had hypoglycaemia and 35 (8.2%) had hyperglycaemia. In multivariate regression analysis, no factor significantly predicted the risk of hypoglycaemia, whereas children co-infected with hepatitis C were at a significant risk of hyperglycaemia (adjusted odds ratio; 2.06, 95% CI; 1.05-8.52, P=0.03). Conclusions: In this study HIV-infected Nigerian children who were not on ART had a low prevalence of hypoglycaemia but a high prevalence of hyperglycaemia. Hepatitis C co-infection was a significant independent risk factor for hyperglycaemia. Sri Lanka Journal of Child Health, 2017; 46 (3): 248-258

Hypoglycemia awareness among insulin-treated patients with diabetes in Malaysia: A cohort subanalysis of the HAT study.

The present Malaysian cohort analysis determined the prevalence of hypoglycemia among patients with type 1 diabetes mellitus (T1DM) or type 2 diabetes mellitus (T2DM) attending primary care- or hospital-based diabetes clinics in Malaysia and their awareness of the symptoms of hypoglycemia. The Hypoglycemia Assessment Tool (HAT) study was a non-interventional, 6-month retrospective and 4-week prospective analysis of hypoglycemic events in 24 countries, using self-assessment questionnaires and diaries among patients with T1DM/T2DM aged ≥18years, using insulin for >12months. This report focuses on prospective data, as they are less prone to recall bias. There were 1153 participants in the Malaysian cohort (114 T1DM; 1039 T2DM). In the prospective period, 50.4% and 33.4% of patients reported ≥1 hypoglycemic events, with estimated rates of 20.3 and 13.1 events per patient-year of exposure in patients with T1DM and T2DM, respectively. 24.8% and 16.1% of patients with T1DM or T2DM, respectively, reported ≥1 nocturnal hypoglycemic event. The majority of patients (96.5%, T1DM; 91.8%, T2DM) knew what hypoglycemia was prior to the study. Impaired awareness was present in 48.0% (T1DM) and 36.9% (T2DM) of patients. In the prospective period, 50% of patients with T1DM or T2DM consulted a doctor or nurse following a hypoglycemia episode. Half of patients with T1DM and a third of patients with T2DM reported ≥1 hypoglycemic event during the prospective period. Although the majority of patients knew the typical features of hypoglycemia, many reported impaired ability to recognize symptoms in real life. The present findings highlight the importance of patient education and physician awareness in dealing with hypoglycemia, in particular the burden of hypoglycemic unawareness. This trial was registered at www.clinicaltrials.gov as NCT01696266 on 26 September 2012.

Risk factors for hypoglycaemia in in-patients with diabetes treated with continuous insulin intravenous infusion

Introduction. Hypoglycaemia is the most frequent complication of diabetes therapy. It leads to unpleasant symptoms and, if severe may, result in coma and even death. Hospitalized patients treated with intravenous insulin therapy are at particularly high risk of hypoglycaemia. Nursing staff play crucial role in preventing, early detecting and treatment of hypoglycaemia caused by insulin given intravenously. Material and methods. This observational, prospective and non-interventional study aimed at assessing prevalence and risk factor of hypoglycaemia during continuous intravenous insulin infusion (CIVII) in a hospital setting. Two hundred consecutive patients (48 with type 1 diabetes and 152 with type 2 diabe­tes) were enrolled into the study. Mean age of type 1 diabetes patients was 38 ± 14 years, and those with type 2 diabetes 61 ± 12 years (p < 0.0001), and their HbA 1c was 10.1 ± 2.9 and 10.1 ± 2.3%, respectively. Continuous intravenous insulin infusion was given for 2.5 ± 1.1 days (basal infusion and three 90-min prandial boluses) according to standard protocol. Results. Hypoglycaemia was noted in 48% of patients with type 1 diabetes and in 20% of those with type 2 diabetes (p < 0.001), most often in the second day of CIVII. In type 1 diabetes, the main risk factor for hypoglycaemia while on CIVII was diabetes duration (the longer duration, the higher the risk) and in type 2 diabetes — daily insulin dose, total and per kg of body weight (the lower the dose, the higher the risk). Conclusions. Continuous intravenous insulin infusion should be used with utmost care in type 1 diabetes patients with long duration of the disease and in those type 2 diabetes patients who show signs of low insulin resistance (little overweight, low insulin requirement).

The Real-Life Effectiveness and Care Patterns of Type 2 Diabetes Management in Greece.

To investigate the prevalence of hypoglycaemia during sulfonylurea (SU) treatment of type 2 diabetes mellitus (T2DM) in Greece and its influence on glycaemic control, treatment adherence and quality of life (QoL). This was a retrospective cross-sectional study. We included 383 T2DM patients ≥30 years old on treatment with SU in monotherapy or in combination with metformin for at least 6 months. Patients were requested to fill in retrospective questionnaires on hypoglycaemia experience, adherence, weight gain and lifestyle/behavioural factors along with QoL (EQ-5D-3L), treatment satisfaction (TSQM), and fear of hypoglycaemia (HFS-II Worry scale). HbA1c<7% was found in 161 (42.0%) patients. In total, 165 (43.1%) patients reported hypoglycaemic symptoms during the previous 6 months: 41.6% (67/161) of those with HbA1c <7% and 44.1% (98/222) of those with HbA1c ≥7%. Glycaemic control was achieved by 43.1% (94/218) of patients without hypoglycaemia and 50.0% (41/82), 36.8% (25/68) and 6.7% (1/15) of patients with mild, moderate or severe hypoglycaemia, respectively (p=0.013). In multivariate analysis, both occurrence (none vs. mild/moderate/severe) and severity (none vs. mild vs. moderate vs. severe) of hypoglycaemia were significantly associated with impaired global treatment satisfaction (p=0.002 and p<0.0001 respectively) and HFS-II Worry scale scores (both p<0.0001), while lower QoL (EQ-5D (UK) Index) was related to hypoglycaemia severity (p=0.024) only. Finally, treatment adherence was associated with increased (none/mild vs. moderate/severe) hypoglycaemia severity in univariate analysis (p=0.019). A high prevalence of patient treated with SU reported hypoglycaemia in Greek healthcare settings with negative effects on treatment satisfaction, patient worry and adherence. Severity of hypoglycaemic symptoms was associated with reduced glycaemic control.

The Canadian Hypoglycemia Assessment Tool Program: Insights Into Rates and Implications of Hypoglycemia From an Observational Study.

The true prevalence of hypoglycemia in insulin-treated patients with diabetes and its impact on patients, employers and healthcare providers is poorly appreciated owing to a paucity of real-world data. The global Hypoglycemia Assessment Tool (HAT) study addressed this issue, and here we report data from the Canadian cohort of patients. This noninterventional, 6-month retrospective and 4-week prospective study enrolled patients aged ≥18 years receiving insulin treatment for >12 months from community endocrinology practices. Data were collected using self-assessment questionnaires and patient diaries. The primary endpoint was the proportion of patients experiencing ≥1 hypoglycemic event during the 4-week prospective observational period. Four hundred ninety-eight patients with type 1 diabetes (n=183) and type 2 diabetes (n=315) were enrolled. The prevalence of hypoglycemia was similar in the retrospective (type 1 diabetes, 92.3%; type 2 diabetes, 63.5%) and prospective (type 1 diabetes, 95.2%; type 2 diabetes, 64.2%) periods. Prospective rates of any, nocturnal and severe hypoglycemia per patient-year (95% confidence interval) were 69.3 (66.4; 72.2), 14.2 (12.9; 15.6) and 1.8 [1.4; 2.4]. Higher rates were reported retrospectively, reaching significance for nocturnal hypoglycemia per patient-year (30.0 [28.1; 32.0] vs. 14.2 [12.9; 15.6]; p<0.001). Hypoglycemia led to increased healthcare utilization and absenteeism and was associated with potentially harmful self-care behaviours (e.g., reduced or skipped insulin doses) and increased blood glucose self-monitoring. Prevalence and incidence of hypoglycemia were high among insulin-treated patients with diabetes in Canada, and some patients took harmful or costly actions when they experienced hypoglycemia. Identifying the insulin-treated patients who are at greatest risk may help to reduce the incidence of hypoglycemia.

Short communication: Associations between blood glucose concentration, onset of hyperketonemia, and milk production in early lactation dairy cows

The objectives of this study were to describe the associations between hypoglycemia and the onset of hyperketonemia (HYK) within the first 6 wk of lactation, to evaluate the effects of body condition score at calving on glucose concentration, and to study the effects of hypoglycemia on milk production. A total of 621 dairy cows from 6 commercial dairy farms in Germany were enrolled between 1 and 4 d in milk (DIM). Cows were tested twice weekly using an electronic handheld meter for glucose and β-hydroxybutyrate (BHB), respectively, for a period of 42 d. Hypoglycemia was defined as glucose concentration ≤2.2 mmol/L. Hyperketonemia was defined as a BHB concentration ≥1.2 mmol/L. The onset of HYK was described as early onset (first HYK event within the first 2 wk postpartum) and late onset (first HYK event in wk 3 to 6 postpartum). The effect of ketosis status on blood glucose within 42 DIM was evaluated using a generalized linear mixed model. No effect was observed of HYK on glucose concentration in primiparous cows. Multiparous cows with early-onset HYK had a lower glucose concentration (-0.21 mmol/L) compared with nonketotic cows. Overall, primiparous cows had a lower prevalence and incidence of hypoglycemia than multiparous cows. Hypoglycemia in multiparous cows was associated with higher first test-day milk production and 100 DIM milk production. In conclusion, hypoglycemia mainly occurred in multiparous cows with early-onset HYK, whereas primiparous cows were at a lower risk for hypoglycemia.

Effect of oral contraceptives and/or metformin on GLP-1 secretion and reactive hypoglycaemia in polycystic ovary syndrome.

ContextInsulin resistance in polycystic ovary syndrome (PCOS) may increase the risk of reactive hypoglycaemia (RH) and decrease glucagon-like peptide-1 (GLP-1) secretion. The possible effects of treatment with oral contraceptives (OCP) and/or metformin on GLP-1 secretion and risk of RH in PCOS is undetermined.SettingOutpatient clinic.Patients and interventionsRandomized, controlled clinical trial. Ninety women with PCOS were randomized to 12-month treatment with OCP (150 mg desogestrel + 30 mg ethinylestradiol), metformin (2 g/day) or metformin + OCP. Five-hour oral glucose tolerance tests (5-h OGTT) measuring fasting and area under the curve (AUC) for GLP-1, glucose, insulin and C-peptide were performed before and after the intervention period. Sixty-five women completed the study and 34 weight-matched healthy women were included as controls.Main outcome measuresChanges in GLP-1, glucose, insulin and C-peptide during 5-h OGTT.ResultsFasting GLP-1 levels increased during metformin + OCP vs OCP treatment, whereas AUC GLP-1 levels were unchanged during medical treatment. The prevalence of reactive hypoglycemia increased from 9/65 to 14/65 after intervention (P < 0.01) and was more common after treatment with metformin + OCP (increase from 3/23 to 6/23, P = 0.01). Reactive hypoglycaemia was associated with higher insulin and C-peptide levels during 5-h OGTT, but was unassociated with BMI and AUC GLP-1. GLP-1 levels were comparable in PCOS vs controls. AUC GLP-1 levels were significantly lower in obese vs lean patients and were inversely associated with BMI.ConclusionsAUC GLP-1 levels were unchanged during treatment. Increased risk of hypoglycemia during metformin + OCP could be associated with increased insulin secretion.

Clinical and Epidemiological Features and Management of Neonatal Hypoglycemia at the University Teaching Hospital of Treichville (Abidjan-C&amp;#244;te d’Ivoire)

The purpose of this study is to determine the prevalence, the characteristics of hypoglycaemia in the newborn admitted to emergency departments of teaching Hospital of Treichville, Abidjan and to evaluate the relevance of capillary blood glucose in this diagnosis. Patients and Methods: This prospective cross-sectional study was held from 01 February to 25 June 2017 in the Pediatric Emergency Department. It involved 201 newborns under 24 hours of age who consulted in pediatric emergency for any reason. Data were collected from parent direct interviews, analysis of the follow-up record, physical examination of the newborn, results of glucose level in the capillary blood at heel and in venous blood. On dry tube and gray tube (containing sodium fluoride and potassium oxalate), the blood glucose on the latter tube constituting the reference blood glucose, with neonatal hypoglycaemia defined by a venous blood glucose less than or equal to 2.5 mmol/l (0.45 g/l). The statistical tests used were the frequency comparison, the Chi Square, the Fisher Test with a significance threshold p < 0.05 or the Odds-ratio with a confidence interval of 95% and a significance threshold of 5%, but also with the correlation coefficient. Results: Newborns of less than 3 hours of life (70.6%) were the most represented with a male predominance (sex ratio = 2.9). The reasons for consultation were dominated by neurological disorders (36.5%), prematurity (31.8%), and fever (22.2%). The average time to complete the blood glucose test was less than one hour after the sampling in 6.5% of the cases. The mean blood glucose was 0.59 g/l (3.28 mmol/l) with extremes ranging from 0.15 to 1.8 g/l (0.83 mmol/l to 10 mmol/l). The prevalence of hypoglycemia by the instantaneous glycemic method was 15.9%. On tube containing sodium fluoride and potassium oxalate, it was 20.4%, while the prevalence of red blood cell hypoglycemia was 38.1%. A good correlation was found between capillary glycemia and gray tube with r = 0.97. Signs associated with hypoglycemia were predominantly male (p < 0.05), prematurity (p < 0.05). As for cerebral suffering, it had proved to be a protective factor (Fisher: 0.002). The mortality rate was 2.5%. Hypoglycemia was not found. Conclusion: Hypoglycaemia is relatively common in our working setting, particularly in premature infants. However, it should be carefully sought in any newborn admitted to emergency regardless of the reason for admission. The use of capillary blood glucose proves to be a good alternative because it allows a fast management.

Reported hypoglycemia in Type 2 diabetes mellitus patients: Prevalence and practices-a hospital-based study.

Introduction:Hypoglycemia tops the list of hurdles in preventing tight glycemic control in diabetic patients. It is even considered as a cardiovascular risk factor. However, it continues to be a neglected complication with very limited epidemiological data in our country.Aim:To study the self-reported prevalence of hypoglycemia among type 2 diabetic patients and the practices adopted by them during and after the episodes to manage and avert future occurrences.Materials and Methods:It is a questionnaire-based cross-sectional study done using systematic random sampling selecting every 5th patient attending the diabetic Out-Patient (OP) in a tertiary medical college hospital.Results:There were 366 participants with median age of 60 years. Around 96% reported any one symptom of hypoglycemia, but 78% had eaten following the episode and got relieved of the symptoms. Weakness (76.2%) and dizziness (74%) were the most common symptoms reported by the patients. A quarter of them reported having severe attacks requiring somebody's assistance. Most patients resorted to timely meals (85%) to avert future attacks. Patients who took insulin along with oral hypoglycemic agents (OHAs) were at a higher risk (OR = 2.3) for hypoglycemia compared to patients taking only OHAs (P < 0.01).Conclusion:The reported prevalence of hypoglycemia among type 2 diabetes patients is quite high. This finding reiterates the importance of enquiring and educating every diabetic patient about hypoglycemic episodes during every health visit.

Prevalence and Risk Factors of Diabetes Mellitus Among the Inhabitants of Kumasi Metropolis

In Ghana, there is an increasing prevalence of diabetes mellitus (DM) in the adult population, which stood at 3.35% by the end of 2013. About 8000 deaths were reported from diabetes in 2013. Changing dietary patterns and lifestyles are associated with the upsurge of DM and in Kumasi the prevalence is 9%. This work sought to determine DM prevalence and associated risk factors among adults in the Kumasi metropolis. The study involved 113 adults from the Oforikrom sub metro. Body Mass Index (BMI) were calculated from weight and height. Venous blood samples were collected for the determination of fasting blood glucose (FBG) using a spectrophotometer. Systolic and diastolic pressures were determined and socio-demographic data were collected using questionnaires. Mean age of participants was 41.8±1.3 years (females=44.9 and males=34.6, p<0.001), mean BMI was 27.3±0.6 kg/m2 (females=29.4 versus males=22.5 kg/m2, p<0.001) and mean FBG was 4.93±0.1 mmol/L (females= 4.97 versus males=4.84, p=0.55). Prevalence of hypoglycemia was 11.5%, normoglycaemia 74.3%, prediabetes 10.7% and diabetes was 3.5%. Close to 35% and 27% were obese and overweight respectively. More females were overweight or obese (82.3%) than the males (15%), p<0.001. Binary regression analysis showed gender as the only significant predictor of high FBG, with females having a 2.76 (95% CI 0.6, 12.7) increased odds of having high FBG compared to males. BMI, age, exercise, family history and diet were not significant predictors of FBG. In this population there was 3.5% observed prevalence of DM, similar to national prevalence, high prevalence of overweight and obesity, associated with female gender.

Association of azotemia with hypoglycemia in severe acute malnutrition how much concerning?

Background: Hypoglycemia is a known complication of SAM which is to be managed early to prevent morbidity and mortality. There is lack of literature regarding hypoglycemia and its associated factors in SAM children. This study aimed to evaluate predicting factors associated with hypoglycemia in children with severe acute malnutrition (SAM) in NRC.Methods: In this case-control design, we compared clinical and laboratory characteristics of children with and without hypoglycemia taken from a population of 299 children with SAM admitted in NRC.Results: Prevalence of hypoglycemia in SAM was 14%. Amongst the association it was found that deranged creatinine (P value of 0.002, odds ratio 2.9, 95% C.I.1.48 - 5.97) and deranged urea (P value 0.0001, odds ratio 3.6, 95% C.I. 1.79 - 7.2) were statistically significant. Diarrhoea (P value 0.7, odds ratio 1.14, 95% C.I. 0.57 - 2.26), leucocytosis (P value 0.23, odds ratio 0.54, 95% C.I. 0.21 - 2.26), leucopenia ( P value 0.6, odds ratio 0.42, 95% C.I. 0.05 - 3.35) were found statistically insignificant.Conclusions: Azotemia in SAM was found significantly associated with hyponatremia.

Prevalence and prognosis of hypoglycaemia in patients receiving maintenance dialysis.

End-stage renal disease is a common predisposing condition for the development of hypoglycaemia. To determine the effect of hypoglycaemia on the mortality of patients undergoing maintenance dialysis. Retrospective and descriptive analyses were performed in five dialysis centres in the Republic of Korea between June 2002 and August 2008. We enrolled 1685 patients who had undergone dialysis for at least 1 month. We identified 453 episodes of hypoglycaemia in 256 of 1685 patients (15.2%); 189 patients (73.8%) had diabetes, whereas the other patients did not. The occurrence of hypoglycaemia in patients receiving dialysis appeared to be a life-threatening complication because 27.0% of patients died within two days of the onset of a hypoglycaemic episode. Older age, low serum albumin levels and infections were independent risk factors for total mortality in these patients. Furthermore, the absence of diabetes, age and serum glucose levels were independent factors associated with early mortality within two days of the development of hypoglycaemia. Although several factors were associated with mortality, the degree of hypoglycaemia, absence of diabetes and old age were associated with early mortality. Elderly hypoglycaemic patients, especially those without diabetes, should be closely monitored.

Severe hypoglycemia, impaired awareness of hypoglycemia, and self-monitoring in adults with type 1 diabetes: Results from Diabetes MILES—Australia

AimsTo assess prevalence of severe hypoglycemia, awareness and symptoms of hypoglycemia, and their associations with self-monitoring of blood glucose. MethodsDiabetes MILES—Australia Study participants completed validated questionnaires and study-specific items. ResultsOf 642 adults with type 1 diabetes, 21% reported ≥1 severe hypoglycemic event in the past six months, and 21% reported impaired awareness of hypoglycemia (IAH). Severe hypoglycemia was increased four-fold for those with IAH compared with intact awareness (1.4±3.9 versus 0.3±1.0). Of those with IAH, 92% perceived autonomic and 88% neuroglycopenic symptoms, albeit at lower glucose thresholds compared to people with intact awareness. Those with IAH were more likely to perceive both symptom types at the same glucose level or to perceive neuroglycopenic symptoms first (all p<0.001). Eighteen percent with IAH treated hypoglycemia only when they perceived symptoms and another 18% only when their capillary glucose was <3.0mmol/L. ConclusionsOne in five adults with type 1 diabetes had IAH or experienced severe hypoglycemia in the past sixmonths. Total loss of hypoglycemia symptoms was rare; most people with IAH retained autonomic symptoms, perceived at relatively low glucose levels. Frequent self-monitoring of blood glucose prompted early recognition and treatment of hypoglycemia, suggesting severe hypoglycemia risk can be minimized.

Towards national comprehensive gestational diabetes screening-consequences for neonatal outcome and care.

The change from risk-factor-based to nearly comprehensive screening of gestational diabetes (GDM) identifies more but milder cases of the disease. The main aim of this study was to evaluate the effect of this screening policy change on neonatal outcomes and care. A population-based register study in Finland. GDM cases during risk-factor-based (year 2006, n=5179) and comprehensive (2010, n=6679) screenings were identified through the Medical Birth Register. All singletons without maternal GDM or prepregnancy diabetes served as controls (n=51746 and n=52386, respectively). The main outcomes were macrosomia, neonatal hypoglycemia and the need for care in a neonatal ward. In the GDM group, the mean birthweight decreased between the study years from 3660g to 3595g and the prevalence of macrosomia from 5.6 to 4.1% even after adjustment for maternal age, parity and prepregnancy body mass index. The adjusted mean difference in birthweight between GDM and control newborns decreased from 70 to 22g between the study years. The prevalence of neonatal hypoglycemia increased from 18.0 to 22.1% in the GDM group. However, neonatal hypoglycemia was more often treated without care in a neonatal ward. The proportion of infants treated on a neonatal ward decreased in both the GDM and control groups between the study years. In newborns, comprehensive GDM screening led to decreased mean birthweight and macrosomia rates, but the prevalence of neonatal hypoglycemia increased. This places substantial demands for delivery hospitals and healthcare resources.

Effects of Glimepiride versus Saxagliptin on β-Cell Function and Hypoglycemia: A Post Hoc Analysis in Older Patients with Type 2 Diabetes Inadequately Controlled with Metformin

PurposeThe management of hyperglycemia is challenging in older patients with type 2 diabetes owing to excess fragility and risk for adverse outcomes should hypoglycemia episodes occur. We evaluated baseline β-cell function as a potential risk factor for the development of hypoglycemia when saxagliptin or glimepiride was added in patients aged ≥65 years whose type 2 diabetes was poorly controlled on stable metformin monotherapy. MethodsA post hoc analysis of data from the GENERATION (Efficacy and Tolerability of Saxagliptin Compared with Glimepiride in Elderly Patients with Type 2 Diabetes: A Randomized, Controlled Study) trial, which enrolled 720 patients aged ≥65 years, was conducted. β-Cell function was assessed using homeostasis model assessment-2%β (HOMA-2%β). FindingsThe percentage of patients experiencing any hypoglycemia event (ie, symptomatic event or event of plasma glucose concentration <54 mg/dL regardless of symptoms) was lower with saxagliptin compared with glimepiride (5.8% vs 34.8%). Regardless of treatment, patients with lower (median HOMA-2%β ≤39.1% [≤median]) versus higher (HOMA-2%β above median value [>median]) baseline β-cell function had a higher hypoglycemia event rate (1.27 vs 0.82 events/patient-year; adjusted incidence rate ratio [IRR] = 1.800; 95% CI, 1.501–2.159). In patients receiving glimepiride, the hypoglycemia event rate was higher in patients with baseline HOMA-2%β ≤median versus >median (2.29 vs 1.60 events/patient-year; adjusted IRR = 1.737; 95% CI, 1.439–2.097); corresponding saxagliptin hypoglycemia event rates were too low to draw meaningful conclusions (0.16 vs 0.09 events/patient-year; adjusted IRR = 2.457; 95% CI, 1.148–5.256). The association between lower β-cell function at baseline and increased prevalence of hypoglycemia was particularly strong in patients aged ≥75 years (adjusted IRR = 2.409; 95% CI, 1.686–3.442; P < 0.001), although it was also significant in patients aged 65 to <75 years old (adjusted IRR, 1.654; 95% CI, 1.339–2.043; P < 0.001). ImplicationsIn patients with lower β-cell function, the addition of a sulfonylurea to a metformin regimen was associated with an increased risk for hypoglycemia compared with that in patients with higher β-cell function; low hypoglycemia event rates with the addition of saxagliptin limited equivalent assessments. These findings in older patients are especially relevant because morbidity associated with hypoglycemia is higher in this age group. ClinicalTrials.gov identifier: NCT01006603 (ClinicalTrials.gov)

Hypoglycaemia in hospitalised neonatal calves: Prevalence, associated conditions and impact on prognosis

Hypoglycaemia has traditionally been associated with neonatal diarrhoea and endotoxaemia in calves, but the clinical relevance of this finding in spontaneously diseased calves has not previously been evaluated. To determine the prevalence and prognostic relevance of severe hypoglycaemia (plasma glucose concentration < 2 mmol/L), data from 10,060 hospitalised calves (≤21 days of age) were retrospectively analysed. Additionally, clinical findings and diagnoses in a subset of 100 calves with severe hypoglycaemia were compared with those in 100 randomly selected calves with initial plasma glucose concentrations in the reference range (4.4–6.9 mmol/L).The prevalence of severe hypoglycaemia in the whole study sample was 6.3%. Severe hypoglycaemia was associated with a poor survival rate of 20.6% vs. 74.0% discharged animals in the group of calves with initial normoglycaemia. Review of medical records revealed that severe hypoglycaemia was significantly associated with clinical or necropsy evidence of septicaemia, hypothermia, history or clinical evidence of malnutrition, and peritonitis of varied origin, but not with the presence of neonatal diarrhoea. Only 10 of 100 calves with severe hypoglycaemia showed central nervous involvement such as seizures and opisthotonus. In conclusion, severe hypoglycaemia has a low prevalence in diseased calves in a hospital setting, but is associated with serious health problems and therefore a high risk of non-survival. Severe hypoglycaemia was not easily diagnosed based on clinical signs, but should be suspected in calves with clinical evidence of septicaemia, hypothermia, acute abdominal emergencies, and a history or clinical evidence of malnutrition.

Assessing occurrence of hypoglycemia and its severity from electronic health records of patients with type 2 diabetes mellitus

AimsAccurate measures of hypoglycemia within electronic health records (EHR) can facilitate clinical population management and research. We quantify the occurrence of serious and mild-to-moderate hypoglycemia in a large EHR database in the US, comparing estimates based only on structured data to those from structured data and natural language processing (NLP) of clinical notes. MethodsThis cohort study included patients with type 2 diabetes identified from January 2009 through March 2014. We compared estimates of occurrence of hypoglycemia derived from diagnostic codes to those recorded within clinical notes and classified via NLP. Measures of hypoglycemia from only structured data (ICD-9 Algorithm), only note mentions (NLP Algorithm), and either structured data or notes (Combined Algorithm) were compared with estimates of the period prevalence, incidence rate, and event rate of hypoglycemia, overall and by seriousness. ResultsOf the 844,683 eligible patients, 119,695 had at least one recorded hypoglycemic event identified with ICD-9 or NLP. The period prevalence of hypoglycemia was 12.4%, 25.1%, and 32.2% for the ICD-9 Algorithm, NLP Algorithm, and Combined Algorithm, respectively. There were 6128 apparent non-serious events utilizing the ICD-9 Algorithm, which increased to 152,987 non-serious events within the Combined Algorithm. ConclusionsAscertainment of events from clinical notes more than doubled the completeness of hypoglycemia capture overall relative to measures from structured data, and increased capture of non-serious events more than 20-fold. The structured data and clinical notes are complementary within the EHR, and both need to be considered in order to fully assess the occurrence of hypoglycemia.

Liberal Glycemic Control in Critically Ill Patients With Type 2 Diabetes: An Exploratory Study.

The optimal blood glucose target in critically ill patients with preexisting diabetes and chronic hyperglycemia is unknown. In such patients, we aimed to determine whether a " liberal" approach to glycemic control would reduce hypoglycemia and glycemic variability and appear safe. Prospective, open-label, sequential-period exploratory study. Medical-surgical ICU. During sequential 6-month periods, we studied 83 patients with preexisting type 2 diabetes and chronic hyperglycemia (glycated hemoglobin, ≥ 7.0% at ICU admission). During the "standard care" period, 52 patients received insulin to treat blood glucose concentrations greater than 10 mmol/L whereas during the "liberal" period, 31 patients received insulin to treat blood glucose concentrations greater than 14 mmol/L. Time-weighted mean glucose concentrations and the number and duration of moderate (< 4.0 mmol/L) and severe (≤ 2.2 mmol/L) hypoglycemic episodes were recorded, with moderate and severe hypoglycemic episodes grouped together. Glycemic variability was assessed by calculating the coefficient of variability for each patient. Safety was evaluated using clinical outcomes and plasma concentrations of markers of inflammation, glucose-turnover, and oxidative stress. Mean glucose (TWglucoseday 0-7, standard care: 9.3 [1.8] vs liberal: 10.3 [2.1] mmol/L; p = 0.02) and nadir blood glucose (4.4 [1.5] vs 5.5 [1.6] mmol/L; p < 0.01) were increased during the liberal period. There was a signal toward reduced risk of moderate-severe hypoglycemia (relative risk: liberal compared with standard care: 0.47 [95% CI, 0.19-1.13]; p = 0.09). Ten patients (19%) during the standard period and one patient (3%) during the liberal period had recurrent episodes of moderate-severe hypoglycemia. Liberal therapy reduced glycemic variability (coefficient of variability, 33.2% [12.9%] vs 23.8% [7.7%]; p < 0.01). Biomarker data and clinical outcomes were similar. In critically ill patients with type 2 diabetes and chronic hyperglycaemia, liberal glycemic control appears to attenuate glycemic variability and may reduce the prevalence of moderate-severe hypoglycemia.

Treatment Outcomes and Tolerability Following Initiation of GLP-1 Receptor Agonists Among Type 2 Diabetes Patients in Primary Care Practices in Germany.

The aim was to investigate real-world treatment outcomes and tolerability of GLP-1 receptor agonist (GLP-1RA) therapy in patients with type 2 diabetes in Germany. Patients from 323 primary care practices who started any GLP-1RA therapy (89 Byetta, 108 Bydureon, 347 Victoza patients) between January 1, 2011, and December 31, 2013 (index date) were analyzed retrospectively (Disease Analyzer database, Germany). Changes from baseline in HbA1c, weight, and hypoglycemia were evaluated in 3 follow-up periods of 0-6, 7-12, and 13-18 months. A total of 544 diabetes patients (mean age: 57.9 years; men: 54%) were eligible for the study. Mean (SD) HbA1c (%) decreased from 8.3 (1.4) at baseline to 7.4 (1.2) in 6 months, 7.6 (1.3) in 7-12 months and 7.6 (1.4) in 13-18 months, respectively ( P < .001 for all), while the proportion of patients with HbA1c <7% increased from 15% at baseline to 38%, 36% and 35% in the corresponding periods ( P < .0001 for all). Multivariate-adjusted beta coefficients corresponding to changes in HbA1c (%) from baseline were -.52, -.44, and -.44, respectively, in the follow-up periods for baseline HbA1c (%) ( P < .0001 for all). The prevalence of hypoglycemia at baseline was 0.7%; this did not change significantly after treatment. In clinical practice, GLP-1RA treatment was associated with improved glycemic control without increased hypoglycemia for up to 18 months. The higher the baseline HbA1c, the greater the HbA1c reduction recorded.

Rates and predictors of hypoglycaemia in 27 585 people from 24 countries with insulin-treated type 1 and type 2 diabetes: the global HAT study.

AimsTo determine the global extent of hypoglycaemia experienced by patients with diabetes using insulin, as there is a lack of data on the prevalence of hypoglycaemia in developed and developing countries.MethodsThis non‐interventional, multicentre, 6‐month retrospective and 4‐week prospective study using self‐assessment questionnaire and patient diaries included 27 585 patients, aged ≥18 years, with type 1 diabetes (T1D; n = 8022) or type 2 diabetes (T2D; n = 19 563) treated with insulin for >12 months, at 2004 sites in 24 countries worldwide. The primary endpoint was the proportion of patients experiencing at least one hypoglycaemic event during the observational period.ResultsDuring the prospective period, 83.0% of patients with T1D and 46.5% of patients with T2D reported hypoglycaemia. Rates of any, nocturnal and severe hypoglycaemia were 73.3 [95% confidence interval (CI) 72.6–74.0], 11.3 (95% CI 11.0–11.6) and 4.9 (95% CI 4.7–5.1) events/patient‐year for T1D and 19.3 (95% CI 19.1–19.6), 3.7 (95% CI 3.6–3.8) and 2.5 events/patient‐year (95% CI 2.4–2.5) for T2D, respectively. The highest rates of any hypoglycaemia were observed in Latin America for T1D and Russia for T2D. Glycated haemoglobin level was not a significant predictor of hypoglycaemia.ConclusionsWe report hypoglycaemia rates in a global population, including those in countries without previous data. Overall hypoglycaemia rates were high, with large variations between geographical regions. Further investigation into these differences may help to optimize therapy and reduce the risk of hypoglycaemia.