title: Incidence, characteristics and impact of hypoglycaemia in patients receiving intensified treatment for inadequately controlled type 2 diabetes mellitus.
abstract: OBJECTIVE
  With the intensification of antidiabetic treatment, there is an increasing risk of hypoglycaemia. We aimed to determine incidence, characteristics and outcomes.
  
  
  METHODS
  Prospective, observational, multicenter cohort study. The included 3810 patients with type 2 diabetes had their treatment intensified at baseline.
  
  
  RESULTS
  The incidence of hypoglycaemia was 11.4% per year with 4.2 ± 4.4 episodes per patient. Hypoglycaemia was more frequent in patients with high blood glucose variability. Predictors were heart failure (odds ratio: 1.66; 95% confidence interval: 1.20-2.29) and insulin use (odds ratio: 4.03; 95% confidence interval: 3.05-5.33), with dipeptidyl peptidase-4 inhibitors being associated with reduced risk (odds ratio: 0.69; 95% confidence interval: 0.53-0.89). Macrovascular events were more frequent among patients reporting severe episodes of hypoglycaemia (odds ratio: 3.39; 95% confidence interval: 1.32-8.73). Microvascular events were more frequent in patients with non-severe episodes (odds ratio: 1.92; 95% confidence interval: 1.49-2.49).
  
  
  CONCLUSIONS
  Case-by-case evaluation of patients as well as appropriate selection of antidiabetic pharmacotherapy and blood glucose treatment goals could maximize the benefits while reducing the risks of antidiabetic treatment.
authors.affiliation: Stiftung 'Der herzkranke Diabetiker' in der Deutschen Diabetes-Stiftung, Bad Oeynhausen, Germany Herz- und Diabeteszentrum Nordrhein-Westfalen, Medizinische Fakultät, Universitätsklinik der Ruhr Universität Bochum, Bad Oeynhausen, Germany diethelm.tschoepe@ruhr-uni-bochum.de.
authors.forename: Diethelm
authors.initials: D
authors.lastname: Tschöpe
authors.affiliation: Institut für Pharmakologie und Präventive Medizin, Mahlow, Germany.
authors.forename: Peter
authors.initials: P
authors.lastname: Bramlage
authors.affiliation: Institut für Herzinfarktforschung, Ludwigshafen, Germany.
authors.forename: Steffen
authors.initials: S
authors.lastname: Schneider
authors.affiliation: Institut für Herzinfarktforschung, Ludwigshafen, Germany Herzzentrum Ludwigshafen, Medizinische Klinik B, Kardiologie, Ludwigshafen, Germany.
authors.forename: Anselm K
authors.initials: AK
authors.lastname: Gitt
mesh_terms: D000368:Aged; D000671:Amputation, Surgical; D060050:Angina, Stable / Q000453:epidemiology; D058070:Asymptomatic Diseases; D001786:Blood Glucose / Q000378:metabolism; D003866:Depressive Disorder / Q000453:epidemiology; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy* / Q000378:metabolism; D003929:Diabetic Neuropathies / Q000453:epidemiology; D003930:Diabetic Retinopathy / Q000453:epidemiology; D054873:Dipeptidyl-Peptidase IV Inhibitors / Q000009:adverse effects / Q000627:therapeutic use; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism; D065089:Glycoside Hydrolase Inhibitors / Q000009:adverse effects / Q000627:therapeutic use; D006333:Heart Failure / Q000453:epidemiology; D006801:Humans; D007003:Hypoglycemia / Q000139:chemically induced* / Q000453:epidemiology; D007004:Hypoglycemic Agents / Q000009:adverse effects*; D015994:Incidence; D007328:Insulin / Q000009:adverse effects / Q000627:therapeutic use; D008297:Male; D008687:Metformin / Q000009:adverse effects / Q000627:therapeutic use; D008875:Middle Aged; D016017:Odds Ratio; D010347:Patient Care Planning; D011446:Prospective Studies; D012307:Risk Factors; D013453:Sulfonylurea Compounds / Q000009:adverse effects / Q000627:therapeutic use; D045162:Thiazolidinediones / Q000009:adverse effects / Q000627:therapeutic use
chemical_list: D001786:Blood Glucose; D054873:Dipeptidyl-Peptidase IV Inhibitors; D006442:Glycated Hemoglobin; D065089:Glycoside Hydrolase Inhibitors; D007004:Hypoglycemic Agents; D007328:Insulin; D008687:Metformin; D013453:Sulfonylurea Compounds; D045162:Thiazolidinediones; C517652:hemoglobin A1c protein, human
keywords: Hypoglycaemia; adverse effects; comorbidity; glucose variability; predictors