Diabetes Management Figure 2: Impact of Hypoglycemia on Patients and the Healthcare System
Reduced medication adherence
Intensive treatment with insulin
Increased incidence of hypoglycemia
Fear of Type 1 diabetes Type 2 diabetes
hypoglycemia Reduced QoL Lost
Tight
glycemic control
productivity Increased
healthcare cost
Compromised glycemic control
Increased diabetic
complications Negative Negative
Impact on healthcare budget and quality of care
Intensive treatment with OADs and insulin
Reduced long-term complications
Improved QoL Decreased healthcare cost Positive
OAD = oral antihyperglycemic drug; QoL = quality of life. Source: adapted from Fidler et al., 2011.40
Table 2: Treatment Options for the Management of Hypoglycemic Unawareness Options
Mechanism Reducing hypoglycemia risk Optimizing insulin treatment
Pharmacological therapy • Alanine
• β2-adrenergic agents • Methylxanthine derivatives • KATP channel modulators • Fructose
Miscellaneous • Blood glucose awareness training
• High-intensity exercise Avoidance of hypoglycemia Idem
Stimulation of glucagon response Enhancement of adrenaline effect CNS stimulation
Modulation of hypoglycemia sensing Idem Improving accuracy of hypoglycemia detection Prevention of exercise-induced hypoglycemia
CNS = central nervous system; KATP = adenosine triphosphate-sensitive potassium. Source: reproduced from de Galan et al., 2006,66
with permission from the editor, Van Zuiden Communications BV.
Fear of hypoglycemia may promote compensatory behaviors such as decreased insulin doses, resulting in poor glycemic control and an increased risk of serious health consequences.40
Economic Impact of Hypoglycemia
The economic impact of HEs in patients with type 2 diabetes is substantial (see Figure 2). A Swedish study estimated the direct and indirect costs of hypoglycemia in type 2 diabetes patients with hypoglycemic symptoms at between $12.90 and $14.10 for a one-month period.41
A recent survey (n=1,404) estimated that lost productivity 98
ranged from $15.26 to $93.47 per HE, representing 8.3–15.9 hours of lost work time per month (see Table 1). Among respondents who experienced an HE at work (n=972), 18.3 % missed work for a mean duration of 9.9 hours. Among those who had HEs outside working hours (including nocturnally), 22.7 % arrived late for work or missed a full day. Nocturnal HEs had the greatest impact on productivity loss, with an average of 14.7 working hours lost.42
Hypoglycemia also represents a considerable economic burden in terms of healthcare systems. Reported costs of a severe HE varied from
US ENDOCRINOLOGY
Comment
Two-to-three weeks is sufficient to improve hypoglycemia unawareness clinically
Effect on counterregulation depends on effectiveness of hypoglycemia avoidance
Not tested in clinical trials Not tested in clinical trials
May be efficacious, but emergence of tolerance may limit effect of long-term use
Not effective in humans, possibly due to inability to cross blood–brain barrier
Promising, but not tested in clinical trials
Intensive program that has only been found effective in the hands of its founders
Single observation in a limited number of subjects
Page 1 |
Page 2 |
Page 3 |
Page 4 |
Page 5 |
Page 6 |
Page 7 |
Page 8 |
Page 9 |
Page 10 |
Page 11 |
Page 12 |
Page 13 |
Page 14 |
Page 15 |
Page 16 |
Page 17 |
Page 18 |
Page 19 |
Page 20 |
Page 21 |
Page 22 |
Page 23 |
Page 24 |
Page 25 |
Page 26 |
Page 27 |
Page 28 |
Page 29 |
Page 30 |
Page 31 |
Page 32 |
Page 33 |
Page 34 |
Page 35 |
Page 36 |
Page 37 |
Page 38 |
Page 39 |
Page 40 |
Page 41 |
Page 42 |
Page 43 |
Page 44 |
Page 45 |
Page 46 |
Page 47 |
Page 48 |
Page 49 |
Page 50 |
Page 51 |
Page 52 |
Page 53 |
Page 54 |
Page 55 |
Page 56 |
Page 57 |
Page 58 |
Page 59 |
Page 60 |
Page 61 |
Page 62 |
Page 63 |
Page 64 |
Page 65 |
Page 66 |
Page 67 |
Page 68 |
Page 69 |
Page 70 |
Page 71 |
Page 72 |
Page 73 |
Page 74 |
Page 75 |
Page 76 |
Page 77 |
Page 78 |
Page 79 |
Page 80 |
Page 81 |
Page 82 |
Page 83 |
Page 84