Understanding the economic, daily functioning, and diabetes management burden of non-severe nocturnal hypoglycemic events in Canada: differences between type 1 and type 2

Figures & data

Table 1. Sample demographic characteristics.

	Total sample	Type 1 diabetes	Type 2 diabetes	p Values
Sample size with NSNHE within last month (n)	200	50	150
Age, Mean (SD)	54.5 (12.6)	46.3 (13.2)	57.2 (11.2)	<0.001^a
Range	22–83	22–73	22–83
Gender; Female, n (%)	120 (60.0)	28 (56.0)	92 (61.3)	0.505^b
Ethnicity; n (%)				0.673^b
White/Caucasian	184 (92.0)	45 (90.0)	139 (92.7)
Other (Asian/American Indian/Mixed Race)	14 (7.0)	4 (8.0)	10 (6.7)
Decline to answer	2 (1.0)	1 (2.0)	1 (0.7)
Diabetes duration (years), Mean (SD)	14.4 (10.7)	21.8 (12.8)	11.9 (8.6)	<0.001^a
Range	0.3–48.0	0.3–48.0	1–42.9
Number of medical complications, Mean (SD)	1.2 (1.2)	1.4 (1.4)	1.2 (1.2)	0.214^a
Range	0.0–5.0	0.0–5.0	0.0–5.0
Diabetes Treatment; n (%)				<0.001^b
Insulin	139 (69.5)	50 (100)	89 (59.3)
Orals	61 (30.5)	–	61 (40.7)
Work for pay, n (%)				<0.01^b
Yes	87 (43.5)	32 (64.0)	55 (36.7)
No	113 (56.5)	18 (36.0)	95 (63.3)
Hours worked per week, Mean (SD)	35.7 (10.7)	35.3 (11.2)	35.9 (10.5)	0.789^a
Frequency of NSNHE*; n (%)				<0.01^b
Daily	1 (0.5)	–	1 (0.7)
Not daily, but more than 1 a week	14 (7.0)	2 (4.0)	12 (8.0)
About once a week	17 (8.5)	5 (10.0)	12 (8.0)
Several times a month	70 (35.0)	22 (44.0)	48 (32.0)
1 a month	28 (14.0)	11 (22.0)	17 (11.3)
Only a few times a year	58 (29.0)	10 (20.0)	48 (32.0)
Very rarely	12 (6.0)	–	12 (8.0)

^aAnalysis of variance (ANOVA).

^bChi square.

*About how often do you have night-time hypo episodes (while you are sleeping) that do not require medical attention (such as needing to call an ambulance or go to the emergency room/hospital) or do not require help from anyone else to manage the hypo episode?

Figure 1. Recovery time from an event. A = After you woke up that night, how long did it take to realize you were having a hypo before you did something about it? B = After you woke up that night, how long did it take after realization to do something about the hypo, including monitoring your blood sugar, going to get something to eat or drink, and then eating or drinking it? C = After you woke up that night, how long did it take for all of your acute hypoglycemic symptoms to go away after you had something to eat or drink? D = After you woke up that night, how long did it take before you felt like you were functioning again at your usual or normal level after you had something to eat or drink?

Table 2. Impact of NSNHE on diabetes management.

	Total sample	Type 1 diabetes	Type 2 diabetes	p-Values
Sample size with NSNHE within last month, n	200	50	150
Number of extra blood sugar tests after last NSNHE, Mean (SD)
1st day (day of NSNHE)	1.4 (1.6)	1.2 (1.3)	1.5 (1.6)	0.175^a
2nd day	0.8 (1.4)	0.6 (1.2)	0.8 (1.4)	0.479^a
3rd day	0.5 (1.2)	0.4 (1.0)	0.6 (1.2)	0.307^a
4–7 days	1.4 (4.0)	1.2 (3.4)	1.5 (4.1)	0.558^a
Total (7 days after NSNHE)	4.2 (7.5)	3.3 (6.2)	4.4 (7.9)	0.379^a
Contacted a healthcare professional after last NSNHE, n (%)
Yes^c	29 (14.5)	4 (8.0)	25 (16.7)	0.132^b
Number of insulin users, n	139	50	89
Did your LAST NSNHE cause you to decrease your normal insulin dose?
Yes, n (%)	33 (23.7)	10 (20.0)	23 (25.8)	0.227^b
Days decreased, Mean (SD)	4.8 (7.4)	2.4 (2.1)	5.6 (8.4)	0.340^a
Falls and trips
Did you trip and/or fall during this night-time hypo?				0.625^b
Yes, n (%)	6 (3.0)	2 (4.0)	4 (2.7)

^aAnalysis of variance (ANOVA).

^bChi square.

^cPrimary care doctor, hospital, diabetes clinic, other.

Table 3. Impact of an NSNHE on work productivity.

	Total sample	Type 1 diabetes	Type 2 diabetes	p-Values
Nocturnal NSNHE	(n = 87)	(n = 32)	(n = 55)
How much did hypo impact productivity at work (0 = no impact–10 = extremely negative impact), Mean (SD)	4.4 (3.2)	3.7 (3.4)	4.8 (3.0)	0.130^a
Missing work time (late to work/leave early/miss full day), n (%)	15 (17.2)	6 (18.8)	9 (16.4)	<0.001^b
Missing work time; Full Day, n (%)	4 (4.6)	2 (6.3)	2 (3.6)	<0.001^b
Missing work time; Partial Day (late to work/leave early), n (%)	11 (12.6)	4 (12.5)	7 (12.7)	<0.001^b
If missing work time, what was the amount of work time lost (late to work/leave early/miss full day), Hours, Mean (SD)	3.5 (3.3)	3.3 (2.9)	3.5 (3.7)	0.913^a
n	15	6	9
Because of the hypo, did you: n (%)
Postpone work appointments	9 (10.3)	2 (6.3)	7 (12.7)	0.339^b
Re-schedule work day	16 (18.4)	4 (12.5)	12 (21.8)	0.279^b
Have difficulty focusing or concentrating at work	39 (44.8)	10 (31.3)	29 (52.7)	0.052^b
Not complete work tasks and/or activities in a timely manner	21 (24.1)	6 (18.8)	15 (27.3)	0.370^b
Feel people at work noticed you were experiencing effects of  the hypo from the night before	13 (14.9)	5 (15.6)	8 (14.5)	0.892^b

^aAnalysis of variance (ANOVA).

^bChi-square.

Figure 2. Functional, emotional, and social impact on day after NSNHE.

Table 4. Economic burden of NSNHEs^a.

	Total sample	Type 1 diabetes	Type 2 diabetes
Lost work productivity
Productivity loss of a single NSNHE (in CAD)	14.00	14.60	13.50
Event frequency of NSNHEs per year, Mean (SD)	20.4 (26.4)	18.0 (11.0)	21.3 (29.8)
Productivity loss of NSNHEs per year (in CAD)	4231.10	1633.40	2597.70
Extra blood glucose monitoring
Cost of extra strips per year (in CAD)^b	10,962.28	2740.57	8221.71
Total cost per year (in CAD)	15,193.38	4373.97	10,819.41
Total cost per person per year (in CAD)	70.67	78.11	68.05

^aHourly income used in calculation was CAD 23.53.

^bAssuming each strip costs CAD 0.799.