Seasonal variations of severe hypoglycemia in patients with type 1 diabetes and type 2 diabetes in a German population

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Background and aims: Severe hypoglycemia (SH) is associated with a critical prognosis and has acute life-threatening potential irrespective of diabetes type. Our aim was to highlight seasonal changes in SH in patients with type 1 (T1DM) and type 2 diabetes (T2DM) in a German population. Materials and methods: All SH occurred between 2007 and 2014 in a large tertiary care hospital in a rural area (200.000 inhabitants) were captured. Seasons were scaled according to meteorological conditions. Statistical significant differences between diabetes groups were calculated using the Student's t-test and chi-square test. Furthermore one-way anova with post-hoc LSD-test was performed. Results: A total of 1080 episodes of SH in 747 patients were registered: 37.5% of cases were related to T1DM, 51.7% to T2DM, 3.2% to pancreoprivic diabetes and 7.6% occurred in non-diabetic individuals. In cases with T1DM we observed significantly increased prevalence of SH in spring (27.7%) and summer (28.6%) vs. autumn (21.5%; p = 0.04 and p = 0.02 respectively) and winter (22.2%; p = 0.04 vs. summer). In contrast, there was a more balanced and not significant seasonal distribution of SH in subjects with T2DM (winter 25.3%, spring 26.0%, summer 25.1%, autumn 23.5%). Surprisingly, we found no significant variation in seasonal HbA1c and insulin dose in subjects with T1DM. Conclusion: We found an increased frequency of SH in patients with T1DM in spring and summer which was probably due to short-term impacts like more physical activity. Better seasonal adaptation of insulin therapy in subjects with T1DM could be an appropriate approach to prevent SH.

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