Scripties UMCG - Rijksuniversiteit Groningen
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Masked hypoglycaemia; an underestimated phenomenon in type 2 diabetes mellitus

(2018) Westerik, K. (Kathryn)

Background – Tight glycaemic control has shown an increased risk of hypoglycaemia. Recurrent hypoglycaemic events can exert a large effect on the neurological and cardiovascular system and can cause multiple symptoms and complications like altered cognitive function, seizures and coma. However, an episode of hypoglycaemia is not always recognized (masked), which makes it difficult to get insight in the frequency and duration of hypoglycaemia. So far, the knowledge of the exact occurrence of hypoglycaemic episodes is limited. With the availability of the Flash Glucose Monitoring system, the Freestyle Libre (FGM-FL), assessing the frequency of hypoglycaemic events becomes possible in a real-life setting. Knowledge about the occurrence of hypoglycaemic episodes is important, since it is a major limiting factor of strict glucose regulation. Aim – The aim of this study was to determine the frequency and duration of (masked) hypoglycaemic events in patients affected with type 2 diabetes mellitus (T2DM) by using the FGM-FL. Methods – In this cross-sectional cohort study, a total of 60 patients with T2DM used the FGM-FL for a single 2-week period. Time spent in hypoglycaemic episodes per person per week, frequency and duration of hypoglycaemic episodes was determined. Results – Hypoglycaemic episodes (glucose <3.5mmol/l) occurred at least once in half of this study population. The median [IQR] time per week spent in hypoglycaemic episode was 170[75-776] minutes in this group. In this group, the median [IQR] frequency of which hypoglycaemic events occurred was 3.4[2.0-7.9] times per person per week and the median [IQR] duration was 76[36-121] minutes per episode. Most hypoglycaemic events began around midnight. A rough two-third (67%) of this group did not mention these hypoglycaemic episodes at all. Conclusion – This study shows that (masked) hypoglycaemic events are very common in patients affected with T2DM, in particular long-lasting nocturnal hypoglycaemic events. Further research should point out the relevance and impact of the (masked) hypoglycaemic episodes.

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