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Cited by 180Diabetes Management and ResearchDiabetes Management and EducationDiabetes Treatment and Management

Intensified insulin therapy and the risk of severe hypoglycaemia

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Bott, S., Bott, U., Berger, M., Mühlhauser, I.·1997·Diabetologia
DOI 10.1007/s001250050769
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Abstract

The objectives of the present analyses were to assess the association between HbA1c levels and severe hypoglycaemia (SH, treatment with glucose i.v. or glucagon injection) and to identify predictors of SH in a prospective multicentre trial. The study population consisted of 636 insulin-dependent diabetic patients who had participated in a structured 5-day in-patient group treatment and teaching programme for intensification of insulin therapy (ITTP) in one of 10 hospitals and who were re-examined after 1, 2, 3, and 6 years including assessment of demographic, disease and treatment related parameters, diabetes-related knowledge, behaviour, and emotional coping. At baseline, age (mean +/- SD) was 27 +/- 7 years, diabetes duration 9 +/- 7 years and HbA1c 8.3 +/- 1.9 %. During the 6-year follow-up, the mean HbA1c value improved to 7.6%, and in patients with a diabetes duration of more than 1 year at entry into the study (n = 538) the incidence of SH decreased from 0.28 cases/patient/year during the year preceding the ITTP to 0.17 cases/patient/year. The patient group was divided into decile groups according to mean follow-up HbA1c values. In each group more than 230 patient years could be analysed. Groups with mean HbA1c values of 5.7, 7.0, 7.4, 7.7 and 8.9% had comparable risks of SH (0.15-0.19 cases/patient/year). In a logistic regression analysis, mean HbA1c during follow-up, a history of SH during the year preceding the ITTP, C-peptide level, emotional coping, carrying emergency carbohydrates (as assessed at the 1-year follow-up), and age at onset of diabetes were significant independent predictors of SH. The incidence of SH between centres varied between 0.05 and 0.27 cases/patient/year. In conclusion, in the present analyses no linear or exponential relationship between HbA1c and severe hypoglycaemia could be identified by using simple group comparisons. Applying complex regression analyses, various patient-related predictors of severe hypoglycaemia were identified.

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  • The Insulin Treatment and Training programs developed by Mühlhauser and Berger have reported improved glycemic control comparable with DCCT while reducing the rates of severe hypoglycemia.

    “The Insulin Treatment and Training programs developed by Mühlhauser and Berger (100) have reported improved glycemic control comparable with DCCT while reducing the rates of severe hypoglycemia (101,102).”

    From Hypoglycemia and Diabetes: A Report of a Workgroup of the American Diabetes Association and The Endocrine Society (2013) · cites this paper as [101]

    The Results (page unavailable in our copy) report that mean HbA1c fell from 8.3% to 7.6% after the ITTP, while severe hypoglycaemia fell from 0.28 to 0.17 cases per patient-year. The paper compares its findings with the DCCT in the Discussion, but does not establish that the improvement in glycaemic control was comparable to the DCCT’s; it also cautions that differences between the studies limit comparison. (LLM, conf=0.84)

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  • There is convincing evidence that formal training programs that teach patients to replace insulin "physiologically" by giving background and mealtime/correction doses of insulin can reduce the risk of severe hypoglycemia.

    “There is convincing evidence that formal training programs that teach patients to replace insulin “physiologically” by giving background and mealtime/correction doses of insulin can reduce the risk of severe hypoglycemia.”

    From Hypoglycemia and Diabetes: A Report of a Workgroup of the American Diabetes Association and The Endocrine Society (2013) · cites this paper as [101]

    The Subjects and methods passage describes structured training in background and mealtime insulin dosing, with patients adjusting doses for glucose and carbohydrate intake. The Results and Discussion report fewer severe hypoglycaemic episodes after the programme, but describe the reduction as an association; they do not establish that training itself caused it. The claim’s description of this as convincing evidence that the programmes can reduce risk is therefore stronger than the paper’s finding. (LLM, conf=0.84)

    Experimental — accuracy not yet measured

  • The Insulin Treatment and Training programs developed by Mühlhauser and Berger have reported improved glycemic control comparable with DCCT while reducing the rates of severe hypoglycemia.

    “The Insulin Treatment and Training programs developed by M € uhlhauser and Berger (100) have reported improved glycemic control comparable with DCCT while reducing the rates of severe hypoglycemia (101,102).”

    From Hypoglycemia and Diabetes: A Report of a Workgroup of the American Diabetes Association and The Endocrine Society (2013) · cites this paper as [101]

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Research works printed but not linked: 1

  1. [25]25. Bott U (1995) Emotionale Einstellungen bei Typ-I-Diabe- tikern: Streß und Streßbewa ¨ltigung. In: Kohlmann CW, Kulzer B (eds.) Diabetes und Psychologie -Diagnostische Ansa ¨tze. Hans Huber, Bern Go ¨ttingen Toronto Seattle, pp 83-96

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Authors
Bott, S., Bott, U., Berger, M., & Mühlhauser, I.
Affiliations
Heinrich Heine University Düsseldorf (DE)
ORCID
Berger, M.
Venue
Diabetologia
Publisher
Springer Science and Business Media LLC
Published
1997-07-21
Volume
40
Issue
8
Pages
926-932
ISSN
  • 0012-186X (ISSN-L)
  • 1432-0428
DOI
10.1007/s001250050769
OpenAlex
W2015818981
Cited by
180
References
25
Citations by year
2023: 2 · 2022: 5 · 2021: 4 · 2020: 2 · 2019: 2 · 2018: 4 · 2017: 3 · 2016: 3 · 2015: 9 · 2014: 5 · 2013: 9 · 2012: 12
FWCI
4.29
Type
journal article
Language
en
Open access
Licence
www.springer.com/tdm (tdm)
Locations
  • Diabetologia (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Education
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
Keywords
severe hypoglycemia, intensive insulin therapy, type 1 diabetes, HbA1c, C-peptide, emotional coping, age at onset of diabetes, diabetes duration, hypoglycaemia incidence
MeSH terms
Adult, Diabetes Mellitus, Type 1, Female, Follow-Up Studies, Glycated Hemoglobin, Humans, Hypoglycemia, Hypoglycemic Agents, Insulin, Male, Prospective Studies, Risk Factors, Time Factors, Cohort Studies, Incidence, Logistic Models

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