Predicting the risk of insulin-based hypoglycemia in type 2 diabetes mellitus

This study aimed at predicting which diabetic patients are at risk for developing hypoglycemia with insulin therapy.

Patients with type 2 diabetes mellitus (T2DM) cannot regulate their blood glucose levels, leading to a build-up of glucose in the bloodstream. Lifestyle changes, such as diet and exercise, along with various oral drugs (such as metformin or sitagliptin), help to reduce the levels of glucose in the blood. However, not all patients achieve full control over their disease with standard therapy alone. Adding a long-acting insulin to treatment, such as insulin glargine (lantus), can effectively manage blood glucose levels. However, while insulin causes glucose to enter the cells and can reduce glucose blood levels, insulin treatment may also cause hypoglycemia (dangerously low blood glucose levels). For this reason, many patients are hesitant to start insulin treatment. Therefore, understanding which patients are at risk of developing hypoglycemia with insulin treatment is important. The current study examined whether certain patient characteristics can predict the onset of hypoglycemia with insulin treatment.

This analysis included data from 11 studies, including a total of 2251 patients. All studies explored adding insulin glargine to the treatment of uncontrolled T2DM patients. Studies reported the rate of hypoglycemic events, as well as the type of oral therapies used in addition to insulin, HgbA1c levels (a measurement of average blood glucose levels over the past 3 months), and body mass index.

Results showed that adding insulin glargine to therapy lowered blood glucose levels (to the target of HgbA1c < 7%) in 55% of the patients. Symptoms of hypoglycemia were reported in 1164 (52%) of the patients, but only 1.5% experienced a severe hypoglycemic episode. The odds of developing hypoglycemia were increased in patients with a low body mass index. A 44% increase in the risk for hypoglycemia was seen in patients receiving two oral therapies in addition to insulin.

This analysis concluded that there is a relatively low risk of developing severe hypoglycemia with the addition of insulin glargine to T2DM treatment. The risk for hypoglycemia is higher for patients receiving more than one non-insulin oral therapies, and for patients with a relatively low body mass index.

This study was funded by Sanofi-Aventis, the manufacturers of insulin glargine (lantus).

Consult with your physician regarding the addition of insulin treatment to the management of uncontrolled diabetes.