Epidemiology

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Beleid bij acute hypoglykemie met verminderd bewustzijnPublished by: Werkgroep Ontwikkeling Richtlijnen Eerste Lijn (Worel)Last published: 2022La prise en charge de l’hypoglycémie aiguë chez un patient présentant une diminution de la consciencePublished by: Groupe de Travail Développement de recommmandations de première ligneLast published: 2022

Diabetic hypoglycaemia is a common complication of diabetes both in the US and globally.[1][6][7][8]​​ Hypoglycaemia occurs most commonly in people with type 1 diabetes.[1][2][8][9]​​ However, be aware that hypoglycaemia can occur in people with type 2 diabetes due to treatment with insulin or insulin secretagogues (sulfonylureas and meglitinides).[1][2][8][9]​​​ The total number of hypoglycaemic events in insulin-treated people with type 2 diabetes may be comparable to, or even exceed, that seen in people with type 1 diabetes, a phenomenon attributed to the higher overall prevalence of type 2 diabetes.[2][10]

Incidence of diabetic hypoglycaemia varies in the literature; one systematic review and meta-analysis of 72 studies showed an incidence rate of 14.5 to 42,890 episodes per 1,000 person-years in people with type 1 diabetes and 0.072 to 16,360 episodes per 1,000 person-years in people with type 2 diabetes.[6] In the US, the annual incidence of severe hypoglycaemia in patients with type 1 diabetes ranges from 3.3% to 13.5%, with around 4% of patients who are taking a basal bolus insulin regimen requiring hospitalisation at least once.[11][12]​ In people with type 2 diabetes, increasing duration of diabetes and treatment with insulin result in increased frequency of episodes of hypoglycaemia, with an incidence that is similar to that of people with type 1 diabetes.[13][14]​​​[15][16]​ Older adults, particularly those aged >60 years, have higher rates of hypoglycaemia than younger adults.[1][2][3][17][18][19]​ Young children also have higher rates of hypoglycaemia than young adults.[1][2][3]​​ There is no clear difference in hypoglycaemia incidence between men and women.

The incidence of diabetic hypoglycaemia increases in early pregnancy, particularly at around 10-15 weeks' gestation.[3]​​[20][21][22]​​​​[23]​​​​​​​​​​​​​ In pregnant women with pre-existing type 1 diabetes, severe hypoglycaemia occurs around 3 to 5 times more frequently in early pregnancy (but at a lower incidence in the third trimester) than in the period before pregnancy.[2][24]​ Incidence rates of severe hypoglycaemia have been reported as being as high as 19% to 44% in pregnant women who are treated with intensive insulin therapy.[25] 

Episodes of hypoglycaemia are typically under-reported, and the true incidence is likely to be higher than in the literature.[11] One study of people with type 2 diabetes showed that 75% were unaware of hypoglycaemic episodes that were detected using a continuous glucose monitoring system.[26]

Overall, evidence suggests that there has not been a significant decrease in the incidence of severe hypoglycaemia in people with diabetes over time. One study estimated the age- and sex-standardised rate of severe hypoglycaemia of 1.66 million people with type 2 diabetes in the US taking glucose-lowering drugs, based on data from medical and pharmacy claims between 2006 and 2013, and concluded that the rate of severe hypoglycaemia during this period had not changed.[27] However, there is increasing evidence to suggest that the rates of severe hypoglycaemia in children have declined in developed countries.[28][29][30]

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