title: Insulin analogues and severe hypoglycaemia in type 1 diabetes.
abstract: BACKGROUND
  The effect of insulin analogues on glycaemic control is well-documented, whereas the effect on avoidance of severe hypoglycaemia remains tentative. We studied the frequency of severe hypoglycaemia in unselected patients with type 1 diabetes treated with insulin analogues, human insulin, or mixed regimens.
  
  
  METHODS
  A questionnaire was posted from six Danish diabetes clinics to 6112 unselected patients with type 1 diabetes and filled in by 3861 patients (63.2%). Primary endpoint was number of episodes of severe hypoglycaemia in the preceding year. Mild hypoglycaemia was also reported.
  
  
  RESULTS
  The frequency of severe hypoglycaemic episodes per patient-year in patients receiving long-acting insulin analogues was 1.47±0.18 versus 1.09±0.10 in patients on long-acting human insulin (p=0.01). The frequency of severe hypoglycaemic episodes per patient-year was 1.09±0.11 in patients on short-acting insulin analogues versus 1.26±0.13 in patients on short-acting human insulin (p=0.15), which was statistically significant in an adjusted analysis.
  
  
  CONCLUSIONS
  Severe hypoglycaemia is more frequent in patients with type 1 diabetes treated with long-acting insulin analogues. Confounding by indication may be involved. Clinical intervention trials using insulin analogues in patients prone to severe hypoglycaemia are highly needed.
authors.affiliation: Steno Diabetes Center, Niels Steensens Vej 2, Gentofte, Denmark.
authors.forename: P L
authors.initials: PL
authors.lastname: Kristensen
authors.forename: L S
authors.initials: LS
authors.lastname: Hansen
authors.forename: M J
authors.initials: MJ
authors.lastname: Jespersen
authors.forename: U
authors.initials: U
authors.lastname: Pedersen-Bjergaard
authors.forename: H
authors.initials: H
authors.lastname: Beck-Nielsen
authors.forename: J S
authors.initials: JS
authors.lastname: Christiansen
authors.forename: K
authors.initials: K
authors.lastname: Nørgaard
authors.forename: H
authors.initials: H
authors.lastname: Perrild
authors.forename: H-H
authors.initials: HH
authors.lastname: Parving
authors.forename: B
authors.initials: B
authors.lastname: Thorsteinsson
authors.forename: L
authors.initials: L
authors.lastname: Tarnow
mesh_terms: D000328:Adult; D001786:Blood Glucose / Q000187:drug effects; D003430:Cross-Sectional Studies; D003922:Diabetes Mellitus, Type 1; D005260:Female; D006801:Humans; D007003:Hypoglycemia / Q000139:chemically induced*; D007004:Hypoglycemic Agents / Q000009:adverse effects*; D007328:Insulin / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000627:therapeutic use*; D049528:Insulin, Long-Acting / Q000009:adverse effects / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged
chemical_list: D001786:Blood Glucose; D007004:Hypoglycemic Agents; D007328:Insulin; D049528:Insulin, Long-Acting; C484564:insulin, long-acting, human