Temporal changes in the incidence and predictors of severe hypoglycaemia in type 2 diabetes: The Fremantle Diabetes Study

Adherence to healthy lifestyle behaviors as a preventable risk factor for severe hypoglycemia in people with type 2 diabetes: A longitudinal nationwide cohort study

AIMS/INTRODUCTION

We investigated the associations between a combination of lifestyle factors and changes to these factors and the subsequent risk of severe hypoglycemia (SH) in type 2 diabetes patients.

MATERIALS AND METHODS

Individuals with adult type 2 diabetes who underwent consecutive 2-year interval health screening programs from 2009 to 2012 from the Korean National Health Insurance Service database were included and followed up until 2018. Information on history of smoking status, alcohol consumption and physical activity, as well as changes to these factors, was obtained. The primary outcome was incident SH.

RESULTS

Of the 1,490,233 type 2 diabetes patients, 30,539 (2.1%) patients developed SH. Current smokers and heavy drinkers had increased risk of SH, compared with non-smokers and non-drinkers, respectively (hazard ratio 1.28, 95% confidence interval 1.23-1.34; hazard ratio 1.22, 95% confidence interval 1.15-1.30). However, regular physical activity was associated with reduced SH risk (hazard ratio 0.79, 95% confidence interval 0.77-0.82). A combination of unhealthy lifestyle habits was associated with increased SH risk in a dose-dependent fashion (P for trend <0.001). Compared with participants without changes in their unhealthy lifestyles, participants who improved lifestyles had decreased risk of SH.

CONCLUSIONS

Greater adherence to healthy lifestyle factors and any improvement in unhealthy lifestyle habits were associated with a substantially lower risk of SH in individuals with type 2 diabetes.

Trends of Severe Hypoglycemia in Patients with Type 2 Diabetes in Korea: A Longitudinal Nationwide Cohort Study

To estimate the trends in the prevalence of severe hypoglycemia (SH) in patients with type 2 diabetes in Korea, we investigated the total number of SH episodes among type 2 diabetes patients aged ≥30 years who visited the emergency department between 2002 and 2019, using the Korean National Health Insurance Service database. The prevalence of SH events increased from 2002 to 2012; however, it has decreased gradually since 2012. In 2019, the prevalence of SH was 0.6%, with an incidence rate of 4.43 per 1,000 person‐years. Approximately 23,000 SH events occur every year in Korea. Although the incidence is steadily decreasing, there are a considerable number of SH events in type 2 diabetes patients. The decline in the incidence of SH seems to most likely be due to the increased prescription rate of hypoglycemic agents without hypoglycemia risk, less‐strict treatment goals and the individualization of therapy.

Risk for Imbalanced Blood Glucose Pattern: Construct Analysis and Nursing Diagnosis Proposal

To identify a clinical judgment of susceptibility referring to the development of glycemic fluctuations in adults with Diabetes Mellitus undergoing treatment. Theoretical study with construct analysis. The exploration of the phenomena of glycemic variations provided clues for the description of the blood glucose pattern construct and the proposal of a new risk Nursing diagnosis as a judgment of susceptibility to the balance of this pattern. The risk factors for "Risk for Imbalanced Blood Glucose Pattern" are cognitive dysfunction; excessive alcohol consumption; excessive daily exercise; inadequate follow through with treatment regimen; increased frequency of self-monitoring of blood glucose; inadequate knowledge of disease process; inadequate management of amount of food; inadequate regularity of meal consumption; obesity; overweight; smoking; underweight. The elaboration of "Risk for Imbalanced Blood Glucose Pattern" Nursing diagnosis contributes to the advancement in the Nursing classifications and to the elaboration of planning actions and specific interventions.

Incidence and predictors of vision loss complicating type 2 diabetes: The Fremantle Diabetes Study Phase II

BACKGROUND AND PURPOSE

Although diabetes is associated with multiple ocular complications, there are limited data on the incidence and predictors of visual acuity (VA) loss in type 2 diabetes. The aim of this study was to determine the 4-year cumulative incidence of visual impairment and blindness, and the predictors of vision loss, in a representative community-based cohort.

METHODS

The longitudinal Fremantle Diabetes Study Phase II recruited 1551 participants with type 2 diabetes between 2008 and 2011. Participants attended biennial face-to-face assessments including VA measurement. Multivariable logistic regression was used to determine the predictors of vision loss (defined as a decrease in VA by >10 letters at the Year 4 assessment), excluding those with visual impairment (VA >6/19 and ≤6/48) and blindness (VA >6/48) at baseline.

RESULTS

882 participants with normal/near normal vision at baseline had VA data at Year 4 available. During a median [interquartile range] 4.1 [4.0-4.4] years of follow-up, the cumulative incidences of visual impairment and vision loss were 0.9% (n = 8) and 2.9% (n = 26), respectively. No participants developed blindness and 1.9% (n = 17) improved their VA. Multivariable logistic regression showed baseline smoking (OR: 3.17 (95% CI: 1.15-8.76)), prior severe hypoglycemia (5.59 (1.32-23.61)) and urinary albumin:creatinine ratio (uACR) (1.42 (1.09-1.84) for an increase of 1 in ln(uACR)) had higher odds of vision loss during follow-up.

CONCLUSIONS

Smoking cessation and management strategies that avoid severe hypoglycemia and preserve kidney function may potentially prevent vision loss in people with type 2 diabetes.

Diabetes in the Workplace: the Hazards of Hypoglycemia

PURPOSE OF REVIEW

The effects of hypoglycemia can result in injury, including at work. Our goal was to review the recent medical literature regarding hypoglycemia and occupational injuries and provide guidance to clinicians asked to render opinions regarding fitness for work duties in individuals with diabetes.

RECENT FINDINGS

Recent studies contain conflicting conclusions regarding the occupational risks posed by workers with diabetes. However, the US Federal Motor Carrier Safety Administration concluded there was sufficient evidence to change the rule that previously disqualified commercial drivers with insulin-treated diabetes. Blanket employment policies that disqualify workers with diabetes are unnecessary in many occupational fields. In assessing occupational risks and fitness for duty in workers with diabetes, it is important to perform an individualized assessment of the worker and consider the risk factors for hypoglycemia, information from the treating clinician, essential functions of the job, and, if needed, availability of reasonable accommodations.