Impact of hypoglycemia on patients with type 2 diabetes mellitus and their quality of life, work productivity, and medication adherence

Figures & data

Table 1 Characteristics of survey participants with T2DM who were treated with antihyperglycemic agents

	n (%)
Participants reporting a diagnosis of T2DM	7,239
Treated participants xwith T2DM	6,065 (100.0)
Demographics
Mean age (years ± SD)	60.6±11.5
Sex
Male	3,655 (60.3)
Female	2,410 (39.7)
Race/ethnicity
White	4,658 (76.8)
African American	693 (11.4)
Hispanic	400 (6.6)
Asian	128 (2.1)
American Indian	92 (1.5)
Clinical characteristics
HbA1c(%)
Low (<7.0%)	2,163 (35.7)
Slightly elevated (≥7.0% and ≤8.5%)	1,299 (21.4)
Elevated (>8.5% to ≤11.0%)	247 (4.1)
Seriously elevated (>11.0%)	55 (0.9)
Don’t know	2,186 (36.0)
Mean ± SD	6.9±1.3
Mean BMI (kg/m^2 ± SD)	33.8±7.7
Ever experienced high cholesterol	3,784 (62.4)
Ever experienced hypertension	3,867 (63.8)
Antihyperglycemic agents
Insulin	1,742 (28.7)
Metformin	3,176 (57.3)
Sulfonylureas	2,101 (37.9)
DPP-4 inhibitors	572 (10.3)
GLP-1 agonists	323 (5.8)
Thiazolidinediones	530 (9.6)

Abbreviations: HbA_1c, glycated hemoglobin; BMI, body mass index; DPP-4, dipeptidyl peptidase-4; GLP-1, glucagon-like peptide-1; SD, standard deviation; T2DM, type 2 diabetes mellitus.

Figure 1 Description of population.

Abbreviations: HG, hypoglycemia; T2DM, type 2 diabetes mellitus; AHA, antihyperglycemic agent.

Table 2 Hypoglycemic episodes by demographic profile in participants treated with antihyperglycemic agents

	Recent HG (n=1,688)	Nonrecent HG (n=1,516)	Never HG (n=2,552)
Age, years
18–44	212 (12.5%)a	132 (8.7%)	234 (9.2%)
45–54	324 (19.2%)c	271 (17.9%)	416 (16.3%)
55–64	490 (29.0%)	444 (29.3%)	694 (27.2%)
65+	662 (39.2%)a	669 (44.1%)c	1,208 (47.3%)
Mean (years ± SD)	59.2±11.9a	60.9±10.9	61.3±11.5
Sex
Male	941 (55.8%)a	901 (59.4%)	1,629 (63.8%)
Female	747 (44.3%)a	615 (40.6%)c	923 (36.2%)
Race/ethnicity
White	1,296 (76.8%)	1,154 (76.1%)	1,965 (77.0%)
African American	168 (10.0%)b	196 (12.9%)	301 (11.8%)
Hispanic	118 (7.0%)	104 (6.9%)	159 (6.2%)
Asian	31 (1.8%)	22 (1.5%)c	67 (2.6%)
Native American	42 (2.5%)a	17 (1.1%)	28 (1.1%)

Notes:

a P<0.05 versus both nonrecent HG and never HG groups;

b P<0.05 versus nonrecent HG group only;

c P<0.05 versus never HG group only.

Abbreviations: HG, hypoglycemia; SD, standard deviation; T2DM, type 2 diabetes mellitus.

Table 3 Diabetes-related clinical characteristics by hypoglycemia category in participants treated with antihyperglycemic agents

n (%)	Recent HG (n=1,688)	Nonrecent HG (n=1,516)	Never HG (n=2,552)
HbA1c
Low (<7.0%)	607 (36.0%)	533 (35.2%)	933 (36.6%)
Slightly elevated (≥7.0% to ≤8.5%)	498 (29.5%)a	351 (23.2%)c	420 (16.5%)
Elevated (>8.5% to ≤11.0%)	96 (5.7%)c	65 (4.3%)c	78 (3.1%)
Seriously elevated (>11.0%)	14 (0.8%)	17 (1.1%)	21 (0.8%)
Do not know	456 (27.0%)a	520 (34.3%)c	1,043 (40.9%)
Mean (% ± SD)	7.1±1.3c	7.0±1.3c	6.8±1.3
Antihyperglycemic agentsd
Insulin	777 (46.0%)a	491 (32.4%)c	433 (17.0%)
Metformin	790 (54.8%)c	772 (56.7%)	1,436 (58.8%)
Sulfonylureas	674 (46.7%)a	582 (42.7%)c	748 (30.6%)
DPP-4 inhibitors	135 (9.4%)b	163 (12.0%)	248 (10.2%)
GLP-1 agonists	126 (8.7%)a	87 (6.4%)c	98 (4.0%)
Thiazolidinediones	147 (10.2%)	156 (11.5%)c	206 (8.4%)
BMI (kg/m^2)
Obese (≥30)	1,111 (67.3%)c	984 (66.7%)c	1,545 (61.9%)
Overweight (≥25 to <30)	410 (24.8%)c	375 (25.4%)c	725 (29.0%)
Normal (≥19 to <25)	125 (7.6%)	111 (7.5%)	223 (8.9%)
Underweight (<19)	5 (0.3%)	5 (0.3%)	4 (0.2%)
Mean ± SD	34.0±7.7c	34.0±7.7c	33.3±7.6
CCI score
1	1,004 (59.5)c	947 (62.5)c	1,820 (71.3)
2	317 (18.8)c	287 (18.9)c	392 (15.4)
3	184 (10.9)c	166 (11.0)c	219 (8.6)
4+	183 (10.8)a	116 (7.7)c	121 (4.7)
Mean ± SD	1.88±1.49a	1.72±1.22c	1.52±1.05

Notes:

a P<0.05 versus both nonrecent HG and never HG groups;

b P<0.05 versus nonrecent HG group only;

c P<0.05 versus never HG group only;

d antihyperglycemic agents are not mutually exclusive regimens.

Abbreviations: HbA_1c, glycated hemoglobin; BMI, body mass index; CCI, Charlson Comorbidity Index; DPP-4, dipeptidyl peptidase-4; GLP-1, glucagon-like peptide-1; HG, hypoglycemia; SD, standard deviation; T2DM, type 2 diabetes mellitus.

Table 4 HbA_1c levels by hypoglycemia category in participants who reported HbA_1c levels

n (%)	Recent HG (n=1,215)	Nonrecent HG (n=966)	Never HG (n=1,452)
Low (<7.0%)	607 (50.0%)a	533 (55.2%)b	933 (64.3%)
Slightly elevated (≥7.0% to ≤8.5%)	498 (41.0%)a	351 (36.3%)b	420 (28.9%)
Elevated (>8.5% to ≤11.0%)	96 (7.9%)b	65 (6.7%)	78 (5.4%)
Seriously elevated (>11.0%)	14 (1.2%)	17 (1.8%)	21 (1.5%)
Mean (% ± SD)	7.05±1.27b	6.98±1.27b	6.78±1.26

Notes:

a P<0.05 versus both nonrecent HG and never HG groups;

b P<0.05 versus never HG group only.

Abbreviations: HbA_1c, glycated hemoglobin; HG, hypoglycemia; SD, standard deviation.

Table 5 Percentage of participants reporting hypoglycemia by HbA_1c level

n (%)	Low (<7.0%) n=2,073	Slightly elevated (≥7% to ≤8.5%) n=1,269	Elevated (>8.5% to ≤11.0%) n=239	Seriously elevated (>11.0%) n=52	Do not know n=2,019
Recent HG	607 (29.3)a	498 (39.2)	96 (40.2)	14 (26.9)	456 (22.6)b
Nonrecent HG	533 (25.7)	351 (27.7)	65 (27.2)	17 (32.7)	520 (25.8)
Never HG	933 (45.0)a	420 (33.1)	78 (32.6)	21 (40.4)	1,043 (51.7)b

Notes:

a P<0.05 versus the slightly elevated, elevated, and do not know groups;

b P<0.05 versus the low, slightly elevated, and elevated groups.

Abbreviations: HbA_1c, glycated hemoglobin; HG, hypoglycemia.

Table 6 Morisky Medication Adherence Scale scores in participants taking antihyperglycemic agents

Adherence score	Recent HG (n=1,688)	Nonrecent HG (n=1,516)	Never HG (n=2,552)
High (7)	660 (39.1%)a	691 (45.6%)b	1,411 (55.3%)
Medium (5–6)	733 (43.4%)b	607 (40.0%)b	901 (35.3%)
Low (<5)	295 (17.5%)a	218 (14.4%)b	240 (9.4%)

Notes:

a P<0.05 versus both nonrecent HG and never HG groups;

b P<0.05 versus never HG group only.

Abbreviation: HG, hypoglycemia.

Figure 2 Work productivity in participants taking antihyperglycemic agents.

Notes: Absenteeism refers to mean percentage of work time missed due to health (currently employed full-time people); presenteeism refers to mean percentage impairment while working due to health (currently employed full-time people); work productivity impairment refers to mean overall work impairment due to health. ^aP<0.05 versus nonrecent HG. ^bP<0.001 versus never HG. ^cP=0.001 versus nonrecent HG.
Abbreviation: HG, hypoglycemia.

Figure 3 General health summary scores (Short Form-36) in participants taking antihyperglycemic agents who know their hypoglycemic status.

Abbreviations: PF, physical functioning; RP, role-physical; BP, body pain; GH, general health; VT, vitality; SF, social functioning; RE, role-emotional; MH, mental health; HG, hypoglycemia.

Table 7 Extent of interference with social activities in the previous 4 weeks in participants taking antihyperglycemic agents by HG experience

Frequency	Recent HG (n=1,688)	Nonrecent HG (n=1,516)	Never HG (n=2,552)
Not at all	615 (36.4%)a	691 (45.6%)	1,437 (56.3%)
Slightly	433 (25.7%)b	349 (23.0%)	537 (21.0%)
Moderately	319 (18.9%)b	255 (16.8%)b	342 (13.4%)
Quite a bit	235 (13.9%)a	166 (11.0%)b	176 (6.9%)
Extremely	86 (5.1%)a	55 (3.6%)b	60 (2.4%)

Notes:

a P<0.05 versus both nonrecent HG and never HG groups;

b P<0.05 versus never HG group only.

Abbreviation: HG, hypoglycemia.