Hypoglycemia among Insulin-treated Patients with Diabetes: Egypt Cohort of IO HAT Study

Mohamed Hesham Mohamed Fahmy El Hefnawy1, Talaat Abd el Fattah Abdelaaty2, Atef Abdelmoniem Bassyouni3, Hesham Magdeldin Saleem4, Mohsen Mostafa Mussa Khalid5, Dalia Nabil Toaima6, *, Mohamed Ahmed Gaber Maree7
1 National Institute of Diabetes, Cairo, Egypt
2 Faculty of Medicine, Alexandria University, Chamblion st, El Azareeta, Alexandria, Egypt
3 Department of Internal Medicine, National Institute of Diabetes and Endocrinology, Cairo 11017, Egypt
4 Cairo University Egypt, 9 Al Gameya, Oula, Giza Governorate, Egypt
5 National Institute of Diabetes and Endocrinology, 220 A El-Gazayer st, New Maadi, Cairo, Egypt
6 Medical Department, Novo Nordisk Egypt, 47th building, North 90 st, Fifth settlement, Cairo 11835, Egypt
7 Novo Nordisk Egypt, 47th building, North 90 st, Fifth settlement, New Cairo, Cairo, Egypt

© 2018 El Hefnawy et al.

open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International Public License (CC-BY 4.0), a copy of which is available at: This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

* Address correspondence to this author at the Medical Department, Novo Nordisk Egypt, 47th building, North 90 street, Fifth settlement, Cairo 11835, Egypt; Tel: +201028220905; E-mail;



The study aims to assess the real-world incidence of hypoglycemia in patients with Type 1 Diabetes Mellitus (T1DM) or Type 2 Diabetes Mellitus (T2DM) in Egypt cohort of the International Operations Hypoglycemia Assessment Tool (IO HAT) study.


This is a non-interventional study to estimate hypoglycemia in eligible patients with T1DM or T2DM, aged ≥18 years and treated with insulin for >12 months, who have completed self-assessment questionnaires to record demography, treatment information, and hypoglycemia during the 6-month/4-week retrospective and 4-week prospective periods. Data on hypoglycemia for this sub-analysis were collected from DM patients of Egyptian cohort who were recruited in IO HAT study across 36 sites in Egypt between 22 Nov 2014 and 15 Apr 2015.


Percentage of patients who reported at least one hypoglycemic event in the prospective period was any: T1DM: 96.3% (95% confidence interval [CI]: 89.6%, 99.2%) and T2DM: 93.1% (95% CI: 89.8%, 95.6%) and severe: T1DM: 67.5% (95% CI: 56.1%, 77.6%) and T2DM: 64.2% (95% CI: 58.7%, 69.4%). An estimated rate of any and severe hypoglycemia in the prospective period was 63.3 (95% CI: 57.2, 69.9) events per patient year (PPY) and 28.9 (95% CI: 24.8, 33.4) events PPY, respectively, for patients with T1DM and 32.0 (95% CI: 29.8, 34.3) events PPY and 15.5 (95% CI: 14.0, 17.1) events PPY, respectively, for patients with T2DM. Hypoglycemic rate was independent of glycated hemoglobin levels.


The self-reported hypoglycemia data from Egypt confirms that hypoglycemia is under-reported. The high impact of hypoglycemia on the Egyptian DM patients and healthcare system warrants patient education to prevent hypoglycemia.

Keywords: Hypoglycemia, Insulin, Diabetes Mellitus, International Operations Hypoglycemia Assessment Tool, Egypt, Type 1 Diabetes Mellitus, Type 2 Diabetes Mellitus.