New data from a global survey find four in five people with type 2 diabetes have experienced hypoglycaemia

Four out of five (80%) people with type 2 diabetes have experienced self-treated hypoglycaemia*, with 36% experiencing an episode in the last month.1 These hypoglycaemic episodes also affected the way that patients with type 2 diabetes managed their condition,1 according to the GAPP2™ (Global Attitudes of Patients and Physicians) survey, funded by Novo Nordisk and presented today at the Annual Meeting of the European Association for the Study of Diabetes (EASD).

Nearly half (46%) of the patients in the study reported increasing blood glucose monitoring as a result of their last episode and more than one in 10 altered their long-acting insulin regime.1 In addition, according to the GAPP2™ survey, 16% of people with type 2 diabetes said they had intentionally not taken their insulin as prescribed and 14% had intentionally kept their blood sugar at a higher than recommended level in order to avoid hypoglycaemia during the night.1

Healthcare professionals also said that their prescribing decisions were influenced by the risk of self-treated hypoglycaemia.1 When deciding the type of insulin to prescribe, 82% took the risk of hypoglycaemia into account and more than half (57%) started patients on a lower dose of long-acting insulin than recommended.1

“Self-treated hypoglycaemia represents a significant clinical challenge in type 2 diabetes, influencing both patient and prescriber behaviours in insulin management,” said lead researcher and health psychologist Dr. Meryl Brod of The Brod Group, Mill Valley, USA. “Less than optimal patient responses to self-treated hypoglycaemia and non-adherent behaviour need to be addressed to improve glycaemic control and patient welfare.”

Insulin non-adherence can negatively impact blood sugar control and is an independent predictor of mortality.[2],[3] Furthermore, new data from the GAPP2™ survey confirmed that regardless of hypoglycaemia, dosing irregularities of long-acting insulin remain common.4 However, while patients recognised the clinical consequences of this behaviour, a substantial proportion still intentionally did not take their insulin as prescribed.[4]

• 77% of patients who had reduced a basal insulin dose admitted that on the last occasion they had done so deliberately4
• 63% of patients believed missing doses of basal insulin would have a negative impact on their long-term health4
• 37% said they would feel guilty if they missed a long-acting insulin dose4
• 48% of patients said they had missed a dose of basal insulin altogether4
• 51% said they had mistimed a basal dose by more than two hours4
• 38% said they had reduced a dose of basal insulin4

Maintaining optimal glycaemic control is important because it helps reduce long-term complications for diabetic patients.[5] Symptoms of a hypoglycaemic event (when blood sugar becomes too low) often include pounding heart, trembling, hunger, sweating, difficulty concentrating or confusion.[6]

Initial GAPP2™ data were presented at the Scientific Sessions of the American Diabetes Association (ADA) earlier this year. The full data set will be published by the end of 2012.

*Self-treated hypoglycaemia is an event caused by low blood sugar levels which people with diabetes can treat themselves and which do not require medical assistance.

References

1. Tahrani A, Barnett AH, Brod M, Rana A, Peyrot M. GAPP2™: Global survey finds three quarters of patients experience hypoglycaemia on insulin analogue causing dose irregularities and increased blood glucose monitoring. Presented at the European Association for the Study of Diabetes (EASD) October 2012 (presentation number 222)
2. Currie CJ, Peyrot M, Morgan CL, et al. The impact of treatment noncompliance on mortality in people with type 2 diabetes. Diabetes Care 2012;35:1279-1284
3. Donnelly LA, Morris AD, Evans JMM. Adherence to insulin and its association with glycaemic control in patients with type 2 diabetes. QJ Med 2007;100:345-350
4. Brod M, Peyrot M, Rana A, Barnett AH. GAPP2™: Global survey finds one in eight patients intentionally reduce basal insulin doses to avoid hypoglycaemia. Presented at the European Association for the Study of Diabetes (EASD) October 2012. (presentation number 995)
5. Donnelly LA, Morris AD, Frier BM, et al. Frequency and predictors of hypoglycaemia in Type 1 and insulin-treated Type 2 diabetes: a population-based study. Diabetic Med 2005;22:749-755
6. Brod M, Christensen T, Thomsen TL, Bushnell DM. The impact of non-severe hypoglycemic events on work productivity and diabetes management. Value Health 2011;14:665-671