title: Self-Treated Hypoglycemia in Type 2 Diabetes Mellitus: Results from the Second Wave of an International Cross-Sectional Survey.
abstract: BACKGROUND
  The aim of this study was to assess the total frequency of self-treated hypoglycemia in type 2 diabetes mellitus patients using regimens including basal insulin analogs, and to describe the psychological impact and behavioral response to these events from the perspective of patients and prescribers (i.e., hospital specialists and primary care physicians).
  
  
  METHODS
  The global attitude of patients and physicians 2 (GAPP2) survey was an online multinational, cross-sectional survey of patients with type 2 diabetes mellitus treated with basal insulin analogs, with or without bolus insulin. Prescribers directly involved in the care of these patients were also surveyed. Here, we report the results of the second wave of the GAPP2 survey, in which the primary variable of interest was self-treated hypoglycemia.
  
  
  RESULTS
  A total of 855 patients and 1003 prescribers, from 7 countries, completed the survey. Overall, 28% of patients had experienced self-treated hypoglycemia during the previous 30 days, with two-thirds of events occurring during the day and one-third of events occurring nocturnally. Prescribers reported discussing events with 55% of patients over this period. Patients worried about self-treated hypoglycemia in a range of situations, and prescribers under-estimated this worry. Many patients who had experienced self-treated hypoglycemia in the last 30 days reported missing (19%), mistiming (7%), or reducing (7%) their basal insulin dose as a result.
  
  
  CONCLUSIONS
  Self-treated hypoglycemia was relatively common in patients using basal insulin analogs, with or without bolus insulin. Whilst the frequency of hypoglycemia was greater during the daytime than at night, patients worried more about nocturnal events and this level of worry was under-estimated by physicians. Additional advice and support may be needed for both patients and prescribers, to reduce the frequency and impact of self-treated hypoglycemia.
  
  
  BACKGROUND
  Novo Nordisk.
authors.affiliation: The Brod Group, Mill Valley, CA, USA. mbrod@thebrodgroup.net.
authors.forename: Meryl
authors.initials: M
authors.lastname: Brod
authors.affiliation: Endocrinological Research Center, Moscow, Russian Federation.
authors.forename: Gagik
authors.initials: G
authors.lastname: Galstyan
authors.affiliation: Chellaram Diabetes Institute, Pune, Maharashtra, India.
authors.forename: Ambika Gopalakrishnan
authors.initials: AG
authors.lastname: Unnikrishnan
authors.affiliation: Department of Internal Medicine and the Diabetes Unit, Soroka University Medical Center, Beer-Sheva, Israel.
authors.forename: Ilana
authors.initials: I
authors.lastname: Harman-Boehm
authors.affiliation: Novo Nordisk Pharma Korea, Seoul, Korea.
authors.forename: Vinay
authors.initials: V
authors.lastname: Prusty
authors.affiliation: Autonomous University of Nuevo León, Pedro de Alba S/N, Ciudad Universitaria, San Nicolás de los Garza, Nuevo León, Mexico.
authors.forename: Fernando
authors.initials: F
authors.lastname: Lavalle
authors.affiliation: Sydney Nursing School, University of Sydney, Sydney, New South Wales, Australia.
authors.forename: Margaret
authors.initials: M
authors.lastname: McGill
authors.affiliation: Sunward Park Medical Centre, Johannesburg, South Africa.
authors.forename: Angela
authors.initials: A
authors.lastname: Murphy
authors.affiliation: Hospital de Clínicas, University of Buenos Aires, Buenos Aires, Argentina.
authors.forename: Felix
authors.initials: F
authors.lastname: Puchulu
keywords: GAPP2; Minor hypoglycemia; Nocturnal hypoglycemia; Self-treated hypoglycemia; Type 2 diabetes mellitus