Abstract
Purpose
The aim of the current study is to assess the patient and physician experience and knowledge of hypoglycemia in the management of type 2 diabetes (T2DM).
Methods
T2DM patients (N = 1002) completed questionnaires on hypoglycemia experience, familiarity, and fear. Their responses were compared across various antihyperglycemic treatment regimens; specifically, (1) insulin only or insulin combined with sulfonylurea [SU] and/or metformin, (2) SU only with/without metformin, and (3) neither insulin nor SU. Physicians (N = 1003) completed questionnaires on hypoglycemia knowledge and decision-making, and their responses were compared by specialty [75% primary care providers (PCPs) and 25% endocrinologists].
Results
T2DM patients treated with, (1) insulin only, or (2) insulin plus SU or metformin, reported the most experience and familiarity with—but also fear of—hypoglycemic events. Insulin-treated patients (insulin alone or insulin plus SU/metformin) also reported experiencing more hypoglycemia (all p-values <0.012). For physicians, endocrinology specialty was significantly associated with higher hypoglycemia knowledge scores (all p-values <.001). Irrespective of specialty, physician hypoglycemia knowledge, in turn, was associated with correct treatment decision-making (all p-values <0.001).
Conclusions
Insulin-based antihyperglycemic regimens were associated with high prevalence, severity, familiarity, and fear of hypoglycemia. An effective strategy to mitigate the burden of hypoglycemia may be to optimize pharmacological therapy to prevent these events. Since physician hypoglycemia knowledge was highly correlated to correct therapeutic decision-making, continued physician education regarding this acute complication of diabetes treatment should be prioritized for those managing patients with T2DM.
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Acknowledgements
We would like to acknowledge Lulu Lee for her input on data analysis and Tammy Schuler for her medical writing support.
Author contributions
E.W. and M.P. contributed to the study design, data analysis, result interpretations and manuscript writing. S.J., S.R., R.S., X.H., and S.I. contributed to study design, result interpretations and manuscript writing. All authors provided final approval on the manuscript.
Funding
This work was supported by Merck & Co., Inc., Kenilworth, NJ, USA.
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Dr. Inzucchi has served as a consultant to Janssen, Lexicon, Sanofi, and vTv Therapeutics; has severed on clinical trial steering or executive committees for AstraZeneca, Boehringer Ingelheim, Novo Nordisk, and Daiichi Sankyo; and has participated as a member of a data monitoring committee for Intarcia. Dr. Fisher has served as a consultant for Merck & Co., Inc., Kenilworth, NJ, USA and NovoNordisk. M.P., S.R., R.R.S. are employees and stockholders of Merck & Co., Inc., Kenilworth, NJ, USA. E.W. was employee of Kantar Health when work was completed. X.H. was an employee of Merck & Co., Inc., Kenilworth, NJ, USA at the time when study was conducted.
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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
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Informed consent was obtained from all individual participants included in the study.
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Fisher, S.J., Huang, X., Pawaskar, M. et al. Hypoglycemia in type 2 diabetes: understanding patients’ and physicians’ knowledge and experience. Endocrine 60, 435–444 (2018). https://doi.org/10.1007/s12020-018-1545-0
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DOI: https://doi.org/10.1007/s12020-018-1545-0