Please use this identifier to cite or link to this item:
Title: Incidence and severity of hypoglycaemia in type 2 diabetes by treatment regimen: a UK multi-site 12-month prospective observational study
Authors: Dunkley, A
Fitzpatrick, C
Gray, L
Waheed, G
Heller, S
Frier, B
Davies, M
Khunti, K
First Published: 6-Mar-2019
Publisher: Wiley
Citation: Diabetes, Obesity and Metabolism, 2019
Abstract: Aims To determine the incidence and severity of self‐reported hypoglycaemia in a primary care population with type 2 diabetes. The study also aimed to compare incidence by treatment regimen. Materials and methods A prospective observational study in 17 centres throughout the UK was conducted. Recruitment was based on treatment regimen (metformin alone, sulphonylurea‐, insulin‐ or incretin‐based therapy). Participants were asked to keep a blood glucose diary and self‐report hypoglycaemia episodes [non‐severe (self‐treated) and severe (requiring external help)] over a 12‐month period. Results Three hundred and twenty‐five participants were enrolled, of whom 274 (84%) returned ≥1 monthly diaries. Overall, 39% reported experiencing hypoglycaemia; 32% recorded ≥1 symptomatic, 36% ≥1 non‐severe, and 7% ≥1 severe episodes. By treatment, incidence (events per person/year) for any hypoglycaemia type was 4.39 for insulin, 2.34 for sulphonylurea, 0.76 for metformin, and 0.56 for incretin‐based therapy. Compared with metformin, risk of non‐severe hypoglycaemia was ~3 times higher for participants on sulphonylureas and > 5 times higher for those on insulin [incidence rate ratio (IRR) 3.02 (1.76‐5.18), P < 0.001, and IRR 5.96 (3.48‐10.2), P < 0.001, respectively]. For severe episodes, the incidence for sulphonylurea (0.09) was similar to metformin (0.07) and incretin‐based therapy (0.07); for insulin the risk remained almost 5 times higher than metformin [incidence 0.32; IRR 4.55 (1.28‐16.20), P = 0.019]. Conclusions Hypoglycaemia represents a substantial burden for people with type 2 diabetes. Sulphonylureas and insulin are both associated with a risk of reported non‐severe hypoglycaemia, but only insulin with severe episodes. This suggests the importance of the continued use of sulphonylureas in appropriate patients with type 2 diabetes.
DOI Link: 10.1111/dom.13690
ISSN: 1462-8902
Embargo on file until: 6-Mar-2020
Version: Post-print
Status: Peer-reviewed
Type: Journal Article
Rights: Copyright © 2019, Wiley. Deposited with reference to the publisher’s open access archiving policy. (
Description: The file associated with this record is under embargo until 12 months after publication, in accordance with the publisher's self-archiving policy. The full text may be available through the publisher links provided above.
Appears in Collections:Published Articles, Dept. of Cardiovascular Sciences

Files in This Item:
File Description SizeFormat 
Prospective-HYPO-accepted.pdfPost-review (final submitted author manuscript)767.5 kBAdobe PDFView/Open

Items in LRA are protected by copyright, with all rights reserved, unless otherwise indicated.