Hypoglycemia in type 2 diabetes: understanding patients’ and physicians’ knowledge and experience

Simon J. Fisher, Xingyue Huang, Manjiri Pawaskar, Edward A. Witt, Swapnil Rajpathak, R. Ravi Shankar, Silvio E. Inzucchi

Research output: Contribution to journalArticlepeer-review

7 Scopus citations


Purpose: The aim of the current study is to assess the patient and physician experience and knowledge of hypoglycemia in the management of type 2 diabetes (T2DM). Methods: T2DM patients (N = 1002) completed questionnaires on hypoglycemia experience, familiarity, and fear. Their responses were compared across various antihyperglycemic treatment regimens; specifically, (1) insulin only or insulin combined with sulfonylurea [SU] and/or metformin, (2) SU only with/without metformin, and (3) neither insulin nor SU. Physicians (N = 1003) completed questionnaires on hypoglycemia knowledge and decision-making, and their responses were compared by specialty [75% primary care providers (PCPs) and 25% endocrinologists]. Results: T2DM patients treated with, (1) insulin only, or (2) insulin plus SU or metformin, reported the most experience and familiarity with—but also fear of—hypoglycemic events. Insulin-treated patients (insulin alone or insulin plus SU/metformin) also reported experiencing more hypoglycemia (all p-values <0.012). For physicians, endocrinology specialty was significantly associated with higher hypoglycemia knowledge scores (all p-values <.001). Irrespective of specialty, physician hypoglycemia knowledge, in turn, was associated with correct treatment decision-making (all p-values <0.001). Conclusions: Insulin-based antihyperglycemic regimens were associated with high prevalence, severity, familiarity, and fear of hypoglycemia. An effective strategy to mitigate the burden of hypoglycemia may be to optimize pharmacological therapy to prevent these events. Since physician hypoglycemia knowledge was highly correlated to correct therapeutic decision-making, continued physician education regarding this acute complication of diabetes treatment should be prioritized for those managing patients with T2DM.

Original languageEnglish
Pages (from-to)435-444
Number of pages10
Issue number3
StatePublished - Jun 1 2018

Bibliographical note

Funding Information:
Funding This work was supported by Merck & Co., Inc., Kenilworth, NJ, USA.

Funding Information:
We would like to acknowledge Lulu Lee for her input on data analysis and Tammy Schuler for her medical writing support. E.W. and M.P. contributed to the study design, data analysis, result interpretations and manuscript writing. S.J., S.R., R.S., X.H., and S.I. contributed to study design, result interpretations and manuscript writing. All authors provided final approval on the manuscript. This work was supported by Merck & Co., Inc., Kenilworth, NJ, USA. Dr. Inzucchi has served as a consultant to Janssen, Lexicon, Sanofi, and vTv Therapeutics; has severed on clinical trial steering or executive committees for AstraZeneca, Boehringer Ingelheim, Novo Nordisk, and Daiichi Sankyo; and has participated as a member of a data monitoring committee for Intarcia. Dr. Fisher has served as a consultant for Merck & Co., Inc., Kenilworth, NJ, USA and NovoNordisk. M.P., S.R., R.R.S. are employees and stockholders of Merck & Co., Inc., Kenilworth, NJ, USA. E.W. was employee of Kantar Health when work was completed. X.H. was an employee of Merck & Co., Inc., Kenilworth, NJ, USA at the time when study was conducted.

Publisher Copyright:
© 2018, Springer Science+Business Media, LLC, part of Springer Nature.


  • Antihyperglycemic treatment
  • Hypoglycemia
  • Hypoglycemia fear
  • Treatment decision-making
  • Type 2 diabetes

ASJC Scopus subject areas

  • Endocrinology, Diabetes and Metabolism
  • Endocrinology


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