This study used data from the Danish National Patient Registry to assess trends in the rate of hospitalisation for hypoglycaemia, and predisposing factors and treatments, over the 20 years between 1998 and 2018. Among 44 297 people with type 1 diabetes in the cohort, there were 37 209 hospitalisations for hypoglycaemia. The incidence rate began at 8 per 100 person-years in 1998, peaked at 10 per 100 person-years in 2003 and fell steadily thereafter, reaching a low of 4 per 100 person-years in 2018.
Data on treatment were available for 18 031 people with type 1 diabetes, of whom 5521 were hospitalised for hypoglycaemia. Insulin analogues were associated with lower hypo rates compared with human insulins (both long-acting and fast-acting, as well as premixed), although the confidence intervals overlapped. The insulin analogues glargine and detemir were introduced in 2004, when hospitalisation rates began to fall.
The authors acknowledge a number of study limitations. Data on hospitalisations were used; however, these comprise only a fifth of severe hypoglycaemic episodes. The authors also only analysed the time to first hospitalisation for hypoglycaemia, and not recurrent episodes. Finally, the use of diabetes technology such as insulin pumps and continuous glucose monitoring, which would also have increased over the study period and are likely to have contributed to reduced hospitalisations, was not analysed. Nonetheless, the authors conclude that these safety findings are important and have implications for people on older insulin therapies.
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