Hypoglycaemia in Clinical Diabetes

252 HYPOGLYCAEMIA IN TYPE 2 DIABETES AND IN ELDERLY PEOPLEAfrican-Americans (Miller et al., 2001). A quarter of the group had experienced at leastone episode of hypoglycaemia during the study period. The prevalence of hypoglycaemiaincreased with more intensive treatment, the highest rate being associated with insulin.Severe hypoglycaemia occurred in 0.5% of patients, all of whom had been treated withinsulin. However, this study is limited by its reliance on patient recall of hypoglycaemia andthe ethnicity and gender of the study group, which makes it impossible to extrapolate theoutcomes to European populations.A 12-month prospective multicentre British study tested the hypothesis that the riskof hypoglycaemia in individuals with insulin-treated type 2 diabetes of short duration iscomparable to those taking sulphonylureas and is lower than in patients with newly diagnosedtype 1 diabetes (UK Hypoglycaemia Study Group, 2007). Monthly questionnaires were usedto record self-reported hypoglycaemia and a 72-hour period of continuous blood glucosemonitoring was used at the beginning and end of the study period to detect asymptomatichypoglycaemia. No difference was observed in the prevalences of severe hypoglycaemiain those with type 2 diabetes treated with sulphonylureas, and in individuals with type 2diabetes treated with insulin for less than two years (7% in both groups). Symptomatichypoglycaemia in patients with type 2 diabetes recently commenced on insulin therapy(< 2 years) was considerably lower than in those with type 1 diabetes of less than five yearsduration (median rate one versus 22 episodes per subject per year, p 5 years, showing a significantly higherprevalence in those with a longer duration of insulin therapy.1.0Proportion reporting at least one servere hypo0.80.60.40.20.0type 2 treatedwithsulphonylureastype2 < 2 yrsinsulintype2 > 5 yrsinsulintype1 < 5 yrsinsulintype1 > 15 yrsinsulinFigure 11.3 Proportion of patients with type 1 diabetes for < 5 years and > 15 years, and type2 diabetes in different treatment groups (sulphonylureas, insulin < 2 years, insulin > 5 years), whoexperienced one or more episodes of self-reported severe hypoglycaemia during 9–12 months offollow-up in the UK Hypoglycaemia Group Study. Reproduced from UK Hypoglycaemia Study Group(2007), Diabetologia, with kind permission of Springer Science and Business Media