Hypoglycemia in Type 2 Diabetes--More Common Than You Think: A Continuous Glucose Monitoring Study.
BACKGROUND
Hypoglycemia is often the limiting factor for intensive glucose control in diabetes management, however its actual prevalence in type 2 diabetes (T2DM) is not well documented.


METHODS
A total of 108 patients with T2DM wore a continuous glucose monitoring system (CGMS) for 5 days. Rates and patterns of hypoglycemia and glycemic variability (GV) were calculated. Patient and medication factors were correlated with rates, timing, and severity of hypoglycemia.


RESULTS
Of the patients, 49.1% had at least 1 hypoglycemic episode (mean 1.74 episodes/patient/ 5 days of CGMS) and 75% of those patients experienced at least 1 asymptomatic hypoglycemic episode. There was no significant difference in the frequency of daytime versus nocturnal hypoglycemia. Hypoglycemia was more frequent in individuals on insulin (alone or in combination) (P = .02) and those on oral hypoglycemic agents (P < .001) compared to noninsulin secretagogues. CGMS analysis resulted in treatment modifications in 64% of the patients. T2DM patients on insulin exhibited higher glycemic variability (GV) scores (2.3 ± 0.6) as compared to those on oral medications (1.8 ± 0.7, P = .017).


CONCLUSIONS
CGMS can provide rich data that show glucose excursions in diabetes patients throughout the day. Consequently, unwarranted onset of hypo- and hyperglycemic events can be detected, intervened, and prevented by using CGMS. Hypoglycemia was frequently unrecognized by the patients in this study (75%), which increases their potential risk of significant adverse events. Incorporation of CGMS into the routine management of T2DM would increase the detection and self-awareness of hypoglycemia resulting in safer and potentially better overall control.
Ohio University Heritage College of Osteopathic Medicine/O'Bleness Memorial Hospital, Diabetes Institute, Ohio University, Athens, OH, USA rgehlaut@westernreservehospital.org.
Richa Redhu
RR
Gehlaut
Heritage College of Osteopathic Medicine/CORE Research Office, Ohio University, Athens OH, USA.
Godwin Y
GY
Dogbey
Diabetes Institute, Ohio University, Athens, OH, USA.
Frank L
FL
Schwartz
School of Electrical Engineering and Computer Science, Russ College of Engineering and Technology and the Diabetes Institute, Ohio University, Athens, OH, USA.
Cynthia R
CR
Marling
Touro University California, College of Osteopathic Medicine, Vallejo, CA, USA.
Jay H
JH
Shubrook
D000328:Adult; D000368:Aged; D015374:Biosensing Techniques; D001786:Blood Glucose / Q000032:analysis*; D015190:Blood Glucose Self-Monitoring; D003924:Diabetes Mellitus, Type 2 / Q000097:blood* / Q000188:drug therapy; D005260:Female; D006442:Glycated Hemoglobin; D006801:Humans; D007003:Hypoglycemia / Q000097:blood* / Q000139:chemically induced; D007004:Hypoglycemic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D007328:Insulin / Q000009:adverse effects* / Q000627:therapeutic use; D008875:Middle Aged; D011446:Prospective Studies
D001786:Blood Glucose; D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D007328:Insulin
continuous glucose monitoring system; glycemic variability; hypoglycemia; hypoglycemia unawareness; self-glucose monitoring; type 2 diabetes