Aim: Most people with type 2 diabetes eventually require insulin treatment because of progressive loss of beta-cell function. The most common adverse effect of insulin therapy is hypoglycemia. Recurrent hypoglycemia may lead to impaired awareness of hypoglycemia (IAH) and a consequently high risk for severe hypoglycemia. The aim of this study was to determine the prevalence of IAH and severe hypoglycemia in a large cohort of people with insulin-treated type 2 diabetes.

Methods: The Dutch Diabetes Pearl is a contemporary cohort of people with type 2 diabetes from primary, secondary and tertiary medical centers in the Netherlands. We collected data from people on insulin therapy who had completed the validated Dutch version of the Clarke questionnaire on IAH, where 3 out of 5 points indicate IAH. Descriptive statistics, T-tests and Chi-square tests were performed.

Results: Our study included 1923 patients of whom 59% were men. Median age was 62.1 years (interquartile range 55.1-68.3), median diabetes duration was 13.9 years (8.8-20.1) and median HbA1c was 7.6 % (7.0-8.5). 2individuals (10.8%) were classified as having IAH; these people were more likely to be non-Caucasian and have a lower educational level, and less likely to have a partner. Severe hypoglycemia was reported in 617 patients (32.1%) and severe hypoglycemia requiring medical intervention in the past year in 166 patients (8.6%). People with severe hypoglycemia were more likely to be non-Caucasian, to have a lower educational level, to have a history of cardiovascular events and neuropathic pain, and to use over 10 different types of drugs. No significant associations between HbA1c-levels and IAH or severe hypoglycemia were observed.

Conclusion: IAH and severe hypoglycemia are common in people with type 2 diabetes treated with insulin. Non- Caucasian ethnicity, lower educational level, and being single may be risk factors for IAH in patients with type 2 diabetes.


L. van Meijel: None. F. de Vegt: None. C. Tack: Advisory Panel; Self; Merck Sharp & Dohme Corp., Novo Nordisk A/S, AstraZeneca. Research Support; Self; AstraZeneca. Speaker's Bureau; Self; Novo Nordisk A/S. E.J. Abbink: None. F. Rutters: None. J.M. Dekker: None. B.H. Wolffenbuttel: None. F. Holleman: Other Relationship; Self; Sanofi-Aventis, Bioton, AstraZeneca. J. DeVries: Research Support; Self; Dexcom, Inc., Medtronic, Novo Nordisk A/S. Advisory Panel; Self; Novo Nordisk A/S. Speaker's Bureau; Self; Novo Nordisk A/S, Roche Diabetes Care Health and Digital Solutions. Advisory Panel; Self; Sanofi. Research Support; Self; Senseonics. Speaker's Bureau; Self; Senseonics. Advisory Panel; Self; Zealand Pharma A/S. N. Masurel: None. H. Pijl: None. B. Ozcan: None. B. Silvius: None. B.E. de Galan: Research Support; Self; AstraZeneca, Sanofi. Advisory Panel; Self; Novo Nordisk A/S.

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