Temporal changes in the incidence and predictors of severe hypoglycaemia in type 2 diabetes: The Fremantle Diabetes Study.

AIMS: Since recent changes in therapies and management may have influenced the risk of severe hypoglycaemia complicating type 2 diabetes, we determined its incidence and predictors in community-based patients studied between 2008 and 2013 and compared them with those in a cohort with type 2 diabetes from the same geographical area assessed a decade earlier.

METHODS: We studied 1,551 participants (mean age 65.7 years, 51.9% males) with type 2 diabetes from the longitudinal observational Fremantle Diabetes Study Phase II (FDS2). Severe hypoglycaemia was ascertained as that requiring ambulance attendance, Emergency Department services, and/or hospitalisation. Cox proportional hazards modelling determined predictors of first episode, and negative binomial regression identified predictors of frequency.

RESULTS: Sixty-three patients (4.1%) experienced 83 episodes representing an incidence of 1.34 (95% CI: 1.08-1.67) /100 patient-years (versus 1.67 (1.31-2.13) /100 patient-years in FDS Phase 1; P=0.18). Those experiencing severe hypoglycaemia had 1-4 episodes in both cohorts. Independent predictors of incident severe hypoglycaemia in FDS2 were older age, higher educational attainment, alcohol consumption, current smoking, sulfonylurea/insulin treatment, prior severe hypoglycaemia, renal impairment and plasma N-terminal pro-B-type natriuretic peptide (NT-proBNP). The same variables except smoking were associated with frequency of severe hypoglycaemia. Most of these risk factors paralleled those in Phase 1 but current smoking and plasma NT-proBNP were novel.

CONCLUSIONS: The incidence and frequency of severe hypoglycaemia did not change between FDS Phases but novel risk factors including plasma NT-proBNP were observed in FDS2. This article is protected by copyright. All rights reserved.