Stratifying hypoglycaemic event risk in insulin-treated diabetes

This source preferred by David Kerr

Authors: Heller, S.R. and Kerr, D.

http://www.dft.gov.uk/pgr/roadsafety/research/rsrr/theme6/stratifyinghypoglycaemiceven.pdf

Publisher: Department for Transport

Place of Publication: London

The potential of individuals with diabetes to develop hypoglycaemia during insulin treatment presents a possible risk to them and others in certain safety-critical tasks, such as driving. Restrictions for insulin-treated drivers may limit this risk, but the evidence upon which such restrictions are based is limited. Prior epidemiological and pathophysiological evidence suggests that individuals with Type 2 diabetes in the early stages of insulin treatment may be: • at no greater risk of hypoglycaemia than individuals with Type 2 diabetes treated with sulphonylureas • prone to less severe or less frequent periods of hypoglycaemia compared people with Type 1 diabetes.

1. We have conducted a prospective study, measuring the frequency and type of hypoglycaemia in different groups of individuals with diabetes to test these two hypotheses. This study, reported here, used self-reported hypoglycaemia (measured by questionnaires) and continuous glucose monitoring to record episodes of hypoglycaemia over 9–12 months in the following groups: • Type 1 diabetes of short duration (diagnosed within the past 5 years) • Type 1 diabetes of long duration (on insulin for more than 15 years) • Type 2 diabetes – tablet-treated (using sulphonylurea treatment) • Type 2 diabetes recently started on insulin (treated with twice-daily insulin for less than two years) • Type 2 diabetes on insulin of long duration (taking insulin for over 5 years).

2. There were no significant differences in median rates of low interstitial glucose (LIG) (measured by continuous glucose monitoring) or in rates of self-reported mild or severe hypoglycaemia in those with Type 2 diabetes treated with sulphonylureas when compared to patients with Type 2 diabetes started on insulin over the previous two years.

3. Episodes of hypoglycaemia and LIG in those with Type 1 diabetes of short duration were generally more frequent (with median rates around 10 fold higher in some categories) than in those with Type 2 diabetes recently started on insulin.

4. It was not possible to find risk factors which could conclusively predict hypoglycaemic risk during the period of monitoring. However, the C-peptide level (which measures the capacity of the body to release insulin) was identified as a clinical marker with potential utility as a predictor of hypoglycaemic episodes and worthy of further investigation.

5. We conclude that initiating insulin treatment in individuals with Type 2 diabetes is not necessarily associated with an increased risk of hypoglycaemia in the early stages, compared with that of individuals treated with sulphonylureas.

The data on this page was last updated at 05:17 on May 25, 2020.