High Impact of Unachieved Hypoglycaemia Management in Type 2 Diabetes: From Inadequate Treatment to Non-Perception

Background: Hypoglycaemias represent a frequent acute complication in people with type 2 diabetes on insulin regimens, potentiated by symptoms, associated complications and quality of life reduction. Additionally, frequent episodes and inadequate treatment contribute to a gradual reduction of the ability to perceive hypos. Objective: To identify the occurrence of perceived and unperceived hypoglycaemias in persons with type 2 diabetes on insulin, especially through the use of a continuous glucose monitoring system (CGMS) device, the possible causes for the perceived episodes, and followed treatment. Methods People with type 2 diabetes used CGMS during 7 days, filling in data related with hypoglycaemias occurrence, including recorded glycaemia values, symptoms, estimated causes treatment and the need to get help from others. Results: The participating people with type 2 diabetes (n=60) had a mean age of 60.8±0.9 years, and a mean HbA1c of 7.5±0.1% (58 mmol/mol). One third of the participants reported hypoglycaemia symptoms, identifying 42 situations. 57% of those were confirmed by capillary glucose measurement, 17% were related only with symptoms, and 26% were pseudo-hypoglycaemias. Regarding these documented hypoglycaemias, the most common symptoms were: tremors (63%), visual difficulties (33%), perspiration (29%), hunger (17%), and heat (17%). On the other hand, 45% of participants had 89 episodes of non-perceived hypoglycaemias, of which 15% were of level 2 (≤54mg/dl). We identified non-perceived hypoglycaemias in both people who reported hypoglycaemia symptoms (56%) and people who didn´t report hypoglycaemia symptoms (40%). The causes reported by participants were related with intense or unexpected physical activity (23%), delay between meals (8%), less carbohydrate ingestion at last meal (8%), and excess of insulin administration (8%). Participants were not able to identify any cause in 42% of hypoglycaemia episodes. Taking into account hypoglycaemia therapeutic guidelines, we observed that only 50% were treated accordingly to recommendations (namely, glucose ingestion). Conclusion: A considerable proportion of non-perceived hypoglycaemias was uncovered through the CGMS, in people with type 2 diabetes on insulin, with or without perceived hypoglycaemias. Furthermore, half of the situations where the hypoglycaemia episode was symptomatic were treated in a less than adequate way. Funding Information: This research was supported by the Portuguese NovoNordisk. Declaration of Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article. Ethics Approval Statement: Ethical and regulatory approvals were obtained from the local Ethics Committee at APDP (117/2017).