Evidence map›Paper›PMID 28918198›Full record

ArticlePrimary care diabetes2018

Are we missing hypoglycaemia? Elderly patients with insulin-treated diabetes present to primary care frequently with non-specific symptoms associated with hypoglycaemia.

Suzy V Hope, Phil J Taylor, Beverley M Shields, Andrew T Hattersley, Willie Hamilton

Open access · hybridFull text readComparative Study
PubMed Full text at PMC Publisher
In one paragraph

Article in Primary care diabetes, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 20 papers.

0numbers the graph read from it
0cells of the map it votes in
20citing papers in PubMed
2.3field-weighted citation impact, top 11% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

20 citing papers in PubMed, 46 citations in OpenAlex.

  1. Review
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  11. Asian Best Practices for Care of Diabetes in Elderly (ABCDE).The review of diabetic studies : RDS · 2022
    Article
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  14. Review
  15. Diabetes and Frailty: An Expert Consensus Statement on the Management of Older Adults with Type 2 Diabetes.Diabetes therapy : research, treatment and education of diabetes and related disorders · 2021
    Review
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

5 authors at 3 institutions in 1 country.

Suzy V HopeExeter NIHR Clinical Research Facility, RILD Building, Royal Devon & Exeter Hospital, Barrack Road, Exeter, Devon EX2 5DW, UK. Electronic address: S.V.Hope@exeter.ac.uk.
Phil J TaylorAxminster Medical Practice, St Thomas Court, Church Street, Axminster, EX13 5AG Devon, UK. Electronic address: philtaylor@nhs.net.
Beverley M ShieldsExeter NIHR Clinical Research Facility, RILD Building, Royal Devon & Exeter Hospital, Barrack Road, Exeter, Devon EX2 5DW, UK. Electronic address: B.Shields@exeter.ac.uk.
Andrew T HattersleyExeter NIHR Clinical Research Facility, RILD Building, Royal Devon & Exeter Hospital, Barrack Road, Exeter, Devon EX2 5DW, UK. Electronic address: A.T.Hattersley@exeter.ac.uk.
Willie HamiltonDepartment of Primary Care, University of Exeter Medical School, St Luke's Campus, University of Exeter, Heavitree Rd, Exeter, Devon EX1 2LU, UK. Electronic address: W.Hamilton@exeter.ac.uk.
Royal Devon and Exeter Hospital · GBAxminster Hospital · GBUniversity of Exeter · GB

Funding

Department of HealthWellcome Trust
6 · The paper itself

Abstract

introductionWe assessed if patients with known hypoglycaemia present on other occasions with non-specific symptoms associated with (but not diagnosed as) hypoglycaemia, potentially representing missed hypoglycaemia.

methods335 primary care records (5/2/12-4/2/13) from patients aged >65 (79 on insulin, 85 on sulphonylureas, 121 on metformin only, 50 without diabetes) were assessed for hypoglycaemia episodes and consultations with non-specific symptoms, "hypo clues".

results27/79(34%) insulin-treated patients had >1 documented hypoglycaemia episode, compared to 4/85(5%) sulphonylurea-treated patients, 2/121(2%) metformin-only treated patients, and none without diabetes, p<0.001. "Hypo clue" consultations were common: 1.37 consultations/patient/year in insulin-treated patients, 0.98/patient/year in sulphonylurea-treated, 0.97/patient/year in metformin only-treated, and 0.78/patient/year in non-diabetic patients, p=0.34. In insulin-treated patients with documented hypoglycaemia, 20/27(74%) attended on another occasion with a "hypo clue" symptom, compared to 21/52(40%) of those without hypoglycaemia, p=0.008. No significant difference in the other treatment groups. Nausea, falls and unsteadiness were the most discriminatory symptoms: 7/33(21%) with hypoglycaemia attended on another occasion with nausea compared to 14/302(5%) without hypoglycaemia, p=0.002; 10/33(30%) vs 36/302(12%) with falls, p=0.007; and 5/33(15%) vs 13/302(4%) with unsteadiness, p=0.023.

conclusionsNon-specific symptoms are common in those >65 years. In insulin-treated patients at high hypoglycaemia risk, nausea, falls and unsteadiness should prompt consideration of hypoglycaemia.

Indexed as

Diagnostic ErrorsPrimary Health CareAccidental FallsAgedAge FactorsBiomarkersBlood GlucoseCross-Sectional StudiesDiabetes MellitusFemaleGait Disorders, NeurologicHealth Care SurveysHumansHypoglycemiaHypoglycemic AgentsInsulinBiomarkersBlood GlucoseHypoglycemic AgentsInsulinMetforminSulfonylurea CompoundsDiagnosisElderlyFallsHypoglycaemiaInsulinSymptoms

Identifiers

PMID28918198
PMCPMC5857285
OpenAlexW2754460502

What Socratic holds

Textfull text, public
LicenceCC BY
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.