August 20, 2013

When Does Hypoglycemia Happen?

This is another reason many, if not most, doctors will not prescribe insulin. It seems this is the nemesis that many doctors just can't accept because once the patient leaves the office; they are no longer in control. Hypoglycemia has now been proven to happen at any level of HbA1c and this can only make physicians more nervous. The upsetting information for me is that this is for type 2 diabetes patients.  The study did included several ethnic groups and was evenly divided between male and female.

This study, DISTANCE (diabetes study of Northern California) was a survey. Making the study more useful was the fact that the survey data was linked with clinical, pharmacy, and laboratory data from participants' electronic medical records. The researchers studied the relationship between HbA1c levels and hypoglycemia using a sample of 9094 diabetes patients between the ages of 30 and 77. The patients were from Kaiser Permanente Northern California and were surveyed in 2005 and 2006.
They were treated with glucose-lowering medications in a usual care setting. The patients were asked about severe hypoglycemia requiring assistance during the prior year.

Dr. Kasia Lipska of Yale University, and colleagues reported that as many as 10 percent of patients with type 2 diabetes reported experiencing severe hypoglycemia. Dr, Lipska reports that the risk is high across all levels of glycemic management. Instead of the usual expectations of hypoglycemia being more of a concern as patients are brought to normal glycemia levels, the survey showed that patients at the highest risk of hypoglycemia also included those with very poor glycemic management.

The authors note, few studies have indicated any conclusive relationship between patients in the usual care setting and changes in glycemic management. The duration of diabetes was based on self-report and was categorized as "10 years or less" or "more than 10 years." Participants were evenly split between men and women. The majority of patients were older than 50, with 32.2% of participants ages of 50 to 59 and 33.7% of participants ages 60 to 69.

Participants with diabetes for more than 10 years were more likely to report severe hypoglycemia than those with a duration of 10 years or less (13.9% versus 8.3%). Hypoglycemia was most common in patients receiving insulin therapy (19%) and least common among those using oral glucose-lowering therapies (5.8%). Despite those differences, there was no distinguishing relationship between HbA1c and age, diabetes duration, or category of diabetes medication. Regardless of what you may have read before, hypoglycemia occurs just as often among those with poor blood glucose management as it does for those with excellent blood glucose management.

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