Research Article

Severe hypoglycaemia in 1076 adult patients with type 1 diabetes: influence of risk markers and selection

  1. Ulrik Pedersen-Bjergaard1,*,
  2. Stig Pramming2,
  3. Simon R Heller3,
  4. Tara M Wallace4,
  5. Åse K Rasmussen5,
  6. Hanne V Jørgensen5,
  7. David R Matthews4,
  8. Philip Hougaard2,
  9. Birger Thorsteinsson1

Article first published online: 5 MAY 2004

DOI: 10.1002/dmrr.482

Issue

Diabetes/Metabolism Research and Reviews

Diabetes/Metabolism Research and Reviews

Volume 20, Issue 6, pages 479–486, November/December 2004

Additional Information

How to Cite

Pedersen-Bjergaard, U., Pramming, S., Heller, S. R., Wallace, T. M., Rasmussen, Å. K., Jørgensen, H. V., Matthews, D. R., Hougaard, P. and Thorsteinsson, B. (2004), Severe hypoglycaemia in 1076 adult patients with type 1 diabetes: influence of risk markers and selection. Diabetes/Metabolism Research and Reviews, 20: 479–486. doi: 10.1002/dmrr.482

Author Information

  1. 1

    Department of Internal Medicine F, Hillerød Hospital, Helsevej, Hillerød, Denmark

  2. 2

    Novo Nordisk A/S, Bagsværd, Denmark

  3. 3

    Clinical Sciences Centre, Northern General Hospital, Sheffield, UK

  4. 4

    The Oxford Centre for Diabetes, Endocrinology and Metabolism, Oxford, UK

  5. 5

    Steno Diabetes Center, Gentofte, Denmark

*Department of Internal Medicine F, Hillerød Hospital, Helsevej 2, DK-3400 Hillerød, Denmark.

Publication History

  1. Issue published online: 24 NOV 2004
  2. Article first published online: 5 MAY 2004
  3. Manuscript Accepted: 17 FEB 2004
  4. Manuscript Revised: 3 FEB 2004
  5. Manuscript Received: 27 OCT 2003

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Keywords:

  • hypoglycaemia;
  • type 1 diabetes mellitus;
  • awareness;
  • HbA1c;
  • neuropathy;
  • smoking;
  • ACE;
  • anti-hypertensives

Abstract

Background

Differences between studies in rates of severe hypoglycaemia in type 1 diabetic cohorts are common and poorly understood. The purpose of this study was to assess the frequency of severe hypoglycaemia in unselected patients treated in different secondary care centres and to evaluate the influence of risk markers, clinical setting and selection.

Methods

Cross-sectional Danish–British multicentre survey of 1076 consecutive adult patients with clinical type 1 diabetes who completed a detailed questionnaire on hypoglycaemia and related issues. Key variable was the self-reported rate of severe hypoglycaemia during the preceding year.

Results

The overall rate of severe hypoglycaemia in the preceding year was 1.3 episodes/patient-year and episodes were reported by 36.7% of subjects. The distribution was highly skewed with 5% of subjects accounting for 54% of all episodes. There were no significant differences between countries or centres. Reduced hypoglycaemia awareness, peripheral neuropathy and smoking were the only significant risk markers of severe hypoglycaemia in a stepwise multivariate analysis. In a subgroup selected to be similar to the Diabetes Control and Complications Trial (DCCT) cohort, the rate of severe hypoglycaemia was 0.35 episodes/patient-year and only retinopathy was a significant risk marker together with state of awareness.

Conclusion

Severe hypoglycaemia remains a significant clinical problem in type 1 diabetes. The rate of severe hypoglycaemia and the influence of risk markers are very sensitive to selection and differences in rates between centres or studies seem to disappear after correction for differences in clinical characteristics. Smoking is a novel overall risk marker of severe hypoglycaemia. Copyright © 2004 John Wiley & Sons, Ltd.

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