LMC Diabetes & Endocrinology, Toronto, Ontario, Canada.
LMC Diabetes & Endocrinology, Toronto, Ontario, Canada.
Can J Diabetes. 2018 Feb;42(1):11-17. doi: 10.1016/j.jcjd.2017.01.007. Epub 2017 May 17.
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.
由于缺乏真实世界的数据，人们对接受胰岛素治疗的糖尿病患者中低血糖的真实患病率及其对患者、雇主和医疗保健提供者的影响认识不足。全球低血糖评估工具（HAT）研究解决了这一问题，这里我们报告来自加拿大患者队列的数据。
这项非干预性、为期 6 个月的回顾性和为期 4 周的前瞻性研究纳入了来自社区内分泌科的、接受胰岛素治疗超过 12 个月的年龄≥18 岁的患者。数据通过自我评估问卷和患者日记收集。主要终点是在 4 周前瞻性观察期间经历≥1 次低血糖事件的患者比例。
共纳入 498 例 1 型糖尿病（n=183）和 2 型糖尿病（n=315）患者。回顾性（1 型糖尿病，92.3%；2 型糖尿病，63.5%）和前瞻性（1 型糖尿病，95.2%；2 型糖尿病，64.2%）期间低血糖的患病率相似。每位患者每年（95%置信区间）的任何、夜间和严重低血糖发生率分别为 69.3（66.4；72.2）、14.2（12.9；15.6）和 1.8[1.4；2.4]。回顾性报告的发生率更高，夜间低血糖每位患者每年的发生率达到显著差异（30.0[28.1；32.0] vs. 14.2[12.9；15.6]；p<0.001）。低血糖导致医疗保健利用率和旷工增加，与可能有害的自我护理行为（例如，减少或跳过胰岛素剂量）和增加血糖自我监测有关。
加拿大接受胰岛素治疗的糖尿病患者低血糖的患病率和发生率较高，一些患者在发生低血糖时采取了有害或昂贵的措施。确定处于最大风险的接受胰岛素治疗的患者可能有助于降低低血糖的发生率。
