Individual and societal consequences of hypoglycemia: A cross-sectional survey

Abstract

Background. Hypoglycemia and fear of hypoglycemia threaten individuals’ ability to work and drive. We studied the effect of hypoglycemia on the individual and society, with a focus on possible implications of new European union legislation on patients’ continued ability to drive. Methods. A cross-sectional survey of Danish Diabetes Association members was conducted to investigate individual and societal consequences of hypoglycemia. Results. A total of 3117/9951 individuals with type 1 diabetes (T1DM) (32.2%) or type 2 diabetes (T2DM) (67.8%) completed the survey. The calculated incidence rates of self-reported severe and mild hypoglycemia were 2.9, 0.6 and 0.1 events per patient year (ppy) in patients with T1DM, insulin using T2DM and non-insulin using T2DM, respectively; and incidence rates of self-reported mild hypoglycemia were 99.0, 23.2 and 10.9 events ppy, respectively. Self-care strategies to avoid hypoglycemia include maintaining higher blood glucose levels (45.7%) and reducing physical activity (15.7%). Few people take sick leave as a result of hypoglycemia, but prolonged mental recovery ≥4 h following an episode of mild or severe hypoglycemia was reported by 8.7 and 31.0%, respectively. 26.5% of patients holding a valid driving license reported having ever had at least one episode of severe hypoglycemia. Patients considering underreporting of hypoglycemia to maintain their driving license were more likely to have experienced severe hypoglycemia (odds ratio [OR]: 3.03; 95% CI: 2.42–3.79; p < 0.0001). Conclusion. A high proportion of insulin-treated patients experience hypoglycemia resulting in fear of hypoglycemia and changes in self-care behavior that may compromise glycemic control. Many patients with a history of severe hypoglycemia consider underreporting hypoglycemic events through concern over retaining their driving license.

Keywords :

• Diabetes mellitus
• hypoglycemia
• fear of hypoglycemia
• driving

Declaration of interest

The study was funded by an unconditional grant from Novo Nordisk Scandinavia A/B. B Thorsteinsson is an advisory board member for Eli Lilly. NA Rhee is an employee of Novo Nordisk Scandinavia A/B. CM Burton was paid to provide statistical analyses and medical writing assistance by Novo Nordisk Scandinavia A/B, and is an employee of Point Of Care Medical Consulting. M Dømgaard is an employee of the Danish Diabetes Association. M Bagger was an employee of the Danish Diabetes Association at the time of the completion of the survey, and is currently an employee of Novo Nordisk A/S. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.