Real-world incidence and risk factors for daytime and nocturnal non-severe hypoglycemia in adults with type 2 diabetes mellitus on insulin and/or secretagogues (InHypo-DM Study, Canada)

Aim To estimate the real-world incidence of self-reported non-severe hypoglycemia (NSH) and its related socio-demographic and clinical risk factors in a general population of Canadian adults with type 2 diabetes mellitus (T2DM) taking insulin and/or secretagogues. Methods Data for this study were obtained from the InHypo-DM Study. Self-reported data on the frequency of NSH (past 30 days) as well as socio-demographic and clinical characteristics were collected through an online questionnaire. Risk factors for any, daytime, and nocturnal NSH were identified using multivariable negative binomial regression with backward selection. Results Among 432 adults with T2DM (female: 43.8%, mean age: 53.1 years), 53.9% (95% CI: 49.2% - 58.6%) reported ≥1 event of any (i.e., daytime or nocturnal) NSH in the past 30 days. The 30-day incidence rate of any NSH was 2.3 events per 30 person-days (95% CI: 2.1 - 2.4). Risk factors associated with the increased rate of any NSH were: younger age, lower annual household income, being employed, longer duration of diabetes, higher A1C, and presence of comorbidity. Risk factors were generally similar for daytime NSH (except for the exclusion of diabetes duration and addition of diabetes medication type) and nocturnal NSH (except for the exclusion of being employed). Conclusions This is the largest Canadian investigation to estimate the real-world frequency and distribution of self-reported NSH in T2DM. Events were alarmingly frequent and recurrent. Numerous socio-demographic and clinical risk factors were elucidated. These results highlight the importance of identifying high-risk individuals to minimize future occurrences of hypoglycemia.