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Hypoglycemia risks differ by ethnicity among adults prescribed insulin, sulfonylureas

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November 9, 2018

Among adults with type 2 diabetes, those of black Caribbean ethnicity prescribed insulin are at increased risk for hypoglycemia as are those of black Caribbean, black African or Bangladeshi ethnicity prescribed a sulfonylurea, compared with adults of white British ethnicity, according to findings published in Diabetic Medicine.

Additionally, researchers found a lower risk for hypoglycemia among adults of Indian and Bangladeshi ethnicity with type 2 diabetes when taking insulin vs. sulfonylurea in comparison with other populations.

John Robson, MBBS MSc, MD, FRCGP, clinical reader in primary care research and development in the Centre for Primary Care and Public Health at Queen Mary University of London, and colleagues conducted an observational cohort study using data from electronic health records of 19,771 adults with type 2 diabetes who were patients at 128 general practices in east London. The patients were prescribed insulin or a sulfonylurea 6 months before January 2013 (mean age, 66.2 years; 46.5% women). The study spanned from 2013 to 2015. Study participants were divided into two cohorts based on whether they were prescribed insulin (n = 7,269) or sulfonylurea (n = 12,502). Nine ethnic groups were examined, with those of white British ethnicity (17.3%) used as reference for comparison: Bangladeshi (26%), Indian (10.8%), black Caribbean (9.7%), black African (8.5%), other white (7%), Pakistani (6.7%), other South Asian (3.8%), other black ethnicities (3.5%) and the rest “other” or not recorded.

Among the insulin cohort, hypoglycemic incident rates were highest for adults of black Caribbean ethnicity (adjusted incidence rate ratio [aIRR] = 1.56; 95% CI, 1.21-2.01) compared with adults with white British ethnicity. Adults of Bangladeshi ethnicity had the lowest incidence rate of any of the nine ethnicities in the study (aIRR = 0.49; 95% CI, 0.38-0.64).

Among the sulfonylurea cohort, adults of black Caribbean (aIRR = 1.63; 95% CI, 1.15-2.29), black African (aIRR = 1.9; 95% CI, 1.32-2.75), Indian (aIRR = 1.93; 95% CI, 1.39-2.69) and other South Asian (aIRR = 1.73; 95% CI, 1.09-2.77) ethnicities were at a higher risk for hypoglycemia than those of white British ethnicity.

“The higher risk of hypoglycemia found among black African/Caribbean ethnic groups may be partly explained by relatively intensive glycemia targets in these ethnic groups. Black African/Caribbean and South Asian ethnic groups tend to have higher HbA1c levels at a given blood glucose than their white European counterparts,” the researchers wrote. “Consequently, these individuals may be at greater risk of hypoglycemia than white European populations when lowering HbA1c to national and international glycemic targets.”


The researchers also found that insulin use by adults of Indian (48%; 95% CI, 20.5-66) and Bangladeshi (47.5%; 95% CI, 22.4-65.4) ethnicity decreased hypoglycemic risk compared with sulfonylurea risk.

“South Asian people are known to be less likely to accept insulin and, if prescribed, are more likely to use basal insulins, associated with less dramatic falls in blood glucose when administered,” the researchers wrote. “This may provide some explanation for the significant modifying effect of Bangladeshi and Indian ethnicity on the observed hypoglycemic risk associated with insulin use.” – by Phil Neuffer

Disclosures: Robson reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.


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