The primary cause of hypoglycaemia in
Type 2 diabetes is diabetes medication-in particular, those which raise
insulin levels independently of
blood glucose, such as sulphonylureas (SUs) and exogenous
insulin. The risk of hypoglycaemia is increased in older patients, those with longer diabetes duration, lesser
insulin reserve and perhaps in the drive for strict glycaemic control. Differing definitions, data collection methods,
drug type/regimen and patient populations make comparing rates of hypoglycaemia difficult. It is clear that patients taking
insulin have the highest rates of self-reported severe hypoglycaemia (25% in patients who have been taking
insulin for > 5 years). SUs are associated with significantly lower rates of severe hypoglycaemia. However, large numbers of patients take SUs in the UK, and it is estimated that each year > 5000 patients will experience a severe event caused by their SU
therapy which will require emergency intervention. Hypoglycaemia has substantial clinical impact, in terms of mortality, morbidity and quality of life. The cost implications of severe episodes-both direct hospital costs and indirect costs-are considerable: it is estimated that each hospital admission for severe hypoglycaemia costs around pound1000. Hypoglycaemia and fear of hypoglycaemia limit the ability of current diabetes medications to achieve and maintain optimal levels of glycaemic control. Newer
therapies, which focus on the
incretin axis, may carry a lower risk of hypoglycaemia. Their use, and more prudent use of older
therapies with low risk of hypoglycaemia, may help patients achieve improved
glucose control for longer, and reduce the risk of
diabetic complications.