Changes in incidence of severe hypoglycaemia in people with type 2 diabetes from 2006 to 2016: analysis based on health insurance data in Germany considering the anti‐hyperglycaemic medication. Issue 8 (20th March 2020)

• Record Type: Journal Article
• Authors: Müller, N.; Lehmann, T.; Klöss, A.; Günster, C.; Kloos, C.; Müller, U. A.
• Is Part Of: Diabetic medicine. Volume 37:Issue 8(2020)
• Page Start: 1326
• Page End: 1332
• Publication Date: 2020-03-20
• Subjects: Diabetes -- Periodicals; 616.462
• DOI: 10.1111/dme.14294
• Languages: English
• ISSNs: 0742-3071

Abstract

Abstract: Aim: To investigate the incidence of severe hypoglycaemia over the past 10 years, taking into account changes in anti‐hyperglycaemic therapy. Methods: This retrospective population‐based study used German health insurance data. All adults diagnosed with documented type 2 diabetes (extrapolated to the German population: 6.6 million in 2006; 7.9 million in 2011; 8.86 million in 2016) were screened for severe hypoglycaemia. Anti‐hyperglycaemic agents were identified by Anatomical Therapeutic Chemical (ATC) code. Results: The event rate for severe hypoglycaemia was 460 per 100 000 people in 2006, 490 per 100 000 in 2011 and 360 per 100 000 in 2016. The proportion of people with severe hypoglycaemia receiving sulfonylureas, as well as receiving combination therapy of metformin and sulfonylureas decreased from 2006 to 2016 (23.6% vs. 6.2%) Among those with severe hypoglycaemia in 2006, there were no prescriptions for dipeptidyl peptidase‐4 (DPP‐4) inhibitors, glucagon‐like peptide‐1 (GLP‐1) receptor agonists or sodium–glucose co‐transporter 2 (SGLT2) agonists. The proportions of people with severe hypoglycaemia receiving DPP‐4 inhibitors, GLP‐1 receptor agonists or SGLT2 agonists in 2011 and 2016 were low. The proportion of people receiving human insulin also decreased (from 11.3% in 2006 to 10.3% in 2011 and 4.3% in 2016); the proportion of people receiving insulin analogues increased from 5.4% in 2006 to 11.5% in 2016. Therapy with mixed insulins was used by 19.7% of people with severe hypoglycaemia in 2006, by 14.0% in 2011 and by 7.3% in 2016. People undergoing therapy with insulin analogues have the highest risk of severe hypoglycaemia adjusted by age, gender, nephropathy diagnosis and year of survey [odds ratio (OR) 14.4, 95% confidence interval (95% CI) 13.5–15.5]. Conclusion: The incidence of severe hypoglycaemic events in Germany increased between 2006 and 2011, and decreased in 2016. What's new?: We were able to follow up the incidence of severe hypoglycaemia in a large cohort of people with type 2 diabetes over a period of 10 years. The incidence of severe hypoglycaemia increased from 2006 to 2011 and decreased from 2011 to 2016. The highest risk of severe hypoglycaemia is associated with treatment with insulin analogues, after adjustment for age, sex, nephropathy diagnosis and year.