title: Rates and predictors of hypoglycaemia in 27 585 people from 24 countries with insulin-treated type 1 and type 2 diabetes: the global HAT study.
abstract: To determine the global extent of hypoglycaemia experienced by patients with diabetes using insulin, as there is a lack of data on the prevalence of hypoglycaemia in developed and developing countries.
  
  
  
  This non-interventional, multicentre, 6-month retrospective and 4-week prospective study using self-assessment questionnaire and patient diaries included 27 585 patients, aged ≥18 years, with type 1 diabetes (T1D; n = 8022) or type 2 diabetes (T2D; n = 19 563) treated with insulin for >12 months, at 2004 sites in 24 countries worldwide. The primary endpoint was the proportion of patients experiencing at least one hypoglycaemic event during the observational period.
  
  
  
  During the prospective period, 83.0% of patients with T1D and 46.5% of patients with T2D reported hypoglycaemia. Rates of any, nocturnal and severe hypoglycaemia were 73.3 [95% confidence interval (CI) 72.6-74.0], 11.3 (95% CI 11.0-11.6) and 4.9 (95% CI 4.7-5.1) events/patient-year for T1D and 19.3 (95% CI 19.1-19.6), 3.7 (95% CI 3.6-3.8) and 2.5 events/patient-year (95% CI 2.4-2.5) for T2D, respectively. The highest rates of any hypoglycaemia were observed in Latin America for T1D and Russia for T2D. Glycated haemoglobin level was not a significant predictor of hypoglycaemia.
  
  
  
  We report hypoglycaemia rates in a global population, including those in countries without previous data. Overall hypoglycaemia rates were high, with large variations between geographical regions. Further investigation into these differences may help to optimize therapy and reduce the risk of hypoglycaemia.
authors.affiliation: Diabetes Research Centre, University of Leicester, Leicester, UK.
authors.forename: K
authors.initials: K
authors.lastname: Khunti
authors.affiliation: Al Hada Military Hospital, Taif, Saudi Arabia.
authors.forename: S
authors.initials: S
authors.lastname: Alsifri
authors.affiliation: LMC Diabetes and Endocrinology, Toronto, Canada.
authors.forename: R
authors.initials: R
authors.lastname: Aronson
authors.affiliation: University Hospital 'Sestre Milosrdnice', Zagreb, Croatia.
authors.forename: M
authors.initials: M
authors.lastname: Cigrovski Berković
authors.affiliation: Julius Clinical/Julius Center, UMC Utrecht, Zeist, the Netherlands.
authors.forename: C
authors.initials: C
authors.lastname: Enters-Weijnen
authors.affiliation: Department of General Practice and Primary Health Care, University of Helsinki, Helsinki, Finland.
authors.forename: T
authors.initials: T
authors.lastname: Forsén
authors.affiliation: Endocrinology Research Center, Moscow, Russian Federation.
authors.forename: G
authors.initials: G
authors.lastname: Galstyan
authors.affiliation: Medical Center Haaglanden, The Hague, the Netherlands.
authors.forename: P
authors.initials: P
authors.lastname: Geelhoed-Duijvestijn
authors.affiliation: Clalit Health Services, Tel Aviv, Israel.|The Technion, Haifa, Israel.
authors.forename: M
authors.initials: M
authors.lastname: Goldfracht
authors.affiliation: Novo Nordisk A/S, Søborg, Denmark.
authors.forename: H
authors.initials: H
authors.lastname: Gydesen
authors.affiliation: Novo Nordisk A/S, Søborg, Denmark.
authors.forename: R
authors.initials: R
authors.lastname: Kapur
authors.affiliation: Faculty of Medicine, Clinic for Endocrinology, Diabetes and Metabolic Diseases, Clinical Center of Serbia, University of Belgrade, Belgrade, Serbia.
authors.forename: N
authors.initials: N
authors.lastname: Lalic
authors.affiliation: Rudolfstiftung Hospital and Medical University of Vienna, Vienna, Austria.
authors.forename: B
authors.initials: B
authors.lastname: Ludvik
authors.affiliation: Karolinska Institutet, Stockholm, Sweden.
authors.forename: E
authors.initials: E
authors.lastname: Moberg
authors.affiliation: Nordsjaellands Hospital Hillerød, Hillerød, Denmark.
authors.forename: U
authors.initials: U
authors.lastname: Pedersen-Bjergaard
authors.affiliation: India Diabetes Research Foundation and Dr A Ramachandran's Diabetes Hospitals, Chennai, India.
authors.forename: A
authors.initials: A
authors.lastname: Ramachandran
mesh_terms: D000328:Adult; D000368:Aged; D001210:Asia, Southeastern / Q000453:epidemiology; D002170:Canada / Q000453:epidemiology; D003922:Diabetes Mellitus, Type 1 / Q000188:drug therapy* / Q000378:metabolism; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy* / Q000378:metabolism; D005060:Europe / Q000453:epidemiology; D005061:Europe, Eastern / Q000453:epidemiology; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D007003:Hypoglycemia / Q000139:chemically induced* / Q000453:epidemiology; D007004:Hypoglycemic Agents / Q000009:adverse effects*; D007328:Insulin / Q000009:adverse effects*; D007843:Latin America / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D008877:Middle East / Q000453:epidemiology; D015995:Prevalence; D011446:Prospective Studies; D012189:Retrospective Studies; D012307:Risk Factors; D012426:Russia / Q000453:epidemiology; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires
chemical_list: D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D007328:Insulin; C517652:hemoglobin A1c protein, human
keywords: HAT study; diabetes; global; hypoglycaemia; insulin; observational