How Patients Really Deal With Hypoglycemia

About one-quarter of patients reported missing a dose, mistiming a dose, or reducing a dose of basal insulin in the past 30 days, according to an online survey of the multinational Global Attitude of Patients and Physicians. Researchers from St. Michael’s Hospital in Toronto; the University of Toronto; Novo Nordisk, Canada in Mississauga; and the University of Manitoba, all in Canada, analyzed a Canadian cohort of 156 patients and 202 health care professionals (HCPs). The survey was intended to provide real-world data on how patients prevent or manage hypoglycemia and how they feel about it—then, to compare those responses with what physicians think patients are doing.

Most patients (92%) felt they had moderate or good control of their diabetes. Many (80%) reported having experienced a hypoglycemic event they treated themselves; 33% of these respondents reported an event in the past month. When asked about the last time they had taken a basal insulin dose irregularly, 23% of patients reported missing a dose, 26% reported mistiming a dose, and 13% said they had reduced a dose in the past 30 days. On the last occasion of irregular use, 74% had reduced their basal insulin dose intentionally, usually for hypoglycemia or the risk of hypoglycemia.

Of 51 patients who had experienced at least 1 self-treated hypoglycemic event in the past 30 days, 27% experienced ≥ 5 events. Most patients (88%) experienced at least 1 daytime event; 47% experienced at least 1 hypoglycemic event at night.

Patients who responded to a hypoglycemic event, on average, missed 1.2 doses, mistimed 2.1 doses, or reduced 1.7 doses. Half said they also increased blood glucose monitoring.

The physicians, for their part, had a good grasp on what the patients were doing. They reported similar levels of patient-reported dosing irregularities, and more than 90% of physicians said they recommended patients temporarily reduce their insulin doses to manage their hypoglycemia.

Where the 2 groups differed, however, was in the attitude toward hypoglycemic events. Many patients reported being very or somewhat worried about having an event, more worried than the physicians thought. For example, 44% of patients were concerned about self-treated hypoglycemia in a place where there was no access to food or drink; the physicians reported 15% of patients being concerned about this. Only when it came to daytime hypoglycemia were the patients less concerned than the doctors thought they were.

By and large, the responses indicated that patients were probably following their doctors’ advice. Still, the researchers say, the findings also indicated that patients might benefit from HCPs asking more direct questions about any worries associated with self-treated hypoglycemic events. That could help ensure “that it is not fear of hypoglycemia but rather appropriate responses to changes in schedule, food intake, physical activity, and so forth that prompt dosing changes,” the researchers note. The researchers suggest that patients need more education about considering what is precipitating the hypoglycemic event so they can decide on the appropriate response.

Source
Leiter LA, Boras D, Woo VC. Can J Diabetes. 2014;38(1):38-44.
doi: 10.1016/j.jcjd.2013.08.270.