Antidiabetic pharmacotherapy and anamnestic hypoglycemia in a large cohort of type 2 diabetic patients - an analysis of the DiaRegis registry

Background: We aimed to identify predictors of anamnestic hypoglycaemia in type-2 diabetic patients on oral mono- or dual oral combination antidiabetic pharmacotherapy. Methods: DiaRegis is a prospective registry in type-2 diabetic patients in primary care. Odds ratios (OR) with 95% confidence intervals were determined from univariate logistic regression. Using multivariate logistic regression analysis with stepwise backward selection at an alpha of 0.05 independent predictors of hypoglycaemia were determined. Results: 3,808 patients had data on hypoglycaemia available (median age 65.9 years, 46.6% female). 10.8% had at least one anamnestic hypoglycaemic episode within the previous 12 months. Patients with hypoglycaemia received more sulfonylureas (OR 2.16; 95% CI 1.75-2.67) and less metformin (OR 0.64; 95% CI 0.50-0.82). On top of metformin, patients with thiazolidine (OR 0.50; 95% CI 0.28-0.89) and DPP-4 inhibitor use (OR 0.34; 95% CI 0.16-0.70) had a decreased risk for hypoglycaemia while it was again increased with sulfonylureas (OR 2.08; 95% CI 1.44-2.99). Age < 65 years was an independent predictor of a reduced hypoglycaemia incidence (OR 0.76; 95% CI 0.59-0.96), low Hb(Alc) (OR 1.68; 95% CI 1.31-2.14), stroke/TIA (OR 1.72; 95% CI 1.08-2.72), heart failure (OR 1.77; 95% CI 1.28-2.45), and the use of sulfonylureas (OR 2.58; 95% CI 2.03-3.29) were independent predictors of increased risk. Conclusions: The results indicate that the risk of hypoglycaemia might be substantially reduced by carefully selecting antidiabetic pharmacotherapy in patients with type-2 diabets in primary care.