Hypoglycemia in Type 2 Diabetes: A Survey of Physicians from Three Developing Regions

Abstract

Background

Hypoglycemia in type 2 diabetes (T2D) is primarily linked to certain antihyperglycemic therapies. However, limited data exist on physicians' knowledge and clinical practices regarding hypoglycemia, particularly in developing regions.

Objective

To assess physicians' knowledge of hypoglycemia and accuracy in treatment decision-making across three developing regions with high diabetes prevalence.

Methods

A total of 269 physicians from the Middle East, Africa, and Southeast Asia completed a 6-month online survey (July–December 2021). The questionnaire used multiple-choice and scenario-based questions to evaluate hypoglycemia knowledge, clinical attitudes, and management decisions.

Results

Respondents were mostly senior physicians (78.4%), with 42.4% being endocrinologists. Nearly 79.3% correctly recognized that both type 1 diabetes and T2D are susceptible to hypoglycemia, and insulin (95.5%) and sulfonylureas (83.2%) were most commonly identified as high-risk drugs. Only 53.8% could correctly identify severe hypoglycemia. Top concerns included hypoglycemia unawareness (76.0%), renal failure (61.3%), and advanced age (47.9%). Knowledge significantly varied by specialty, with endocrinologists performing better in scenario-based decision-making.

Conclusion

Physician knowledge of hypoglycemia remains variable. Improving hypoglycemia-related education and optimizing pharmacologic therapy are essential for reducing the risk and fear of hypoglycemia in patients with T2D.

Keywords

hypoglycemia - type 2 diabetes - physician knowledge - treatment decision-making - antihyperglycemic agents - developing countries

Ethical Approval

The study was approved by the Institutional Review Board of Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates. Informed consent was received from the participants before they take the questionnaire.

Publikationsverlauf

Eingereicht: 06. Juni 2025

Angenommen: 22. Juli 2025

Artikel online veröffentlicht:
26. August 2025

• References

• 1 Miller CD, Phillips LS, Ziemer DC, Gallina DL, Cook CB, El-Kebbi IM. Hypoglycemia in patients with type 2 diabetes mellitus. Arch Intern Med 2001; 161 (13) 1653-1659
• 2 Classen DC, Jaser L, Budnitz DS. Adverse drug events among hospitalized Medicare patients: epidemiology and national estimates from a new approach to surveillance. Jt Comm J Qual Patient Saf 2010; 36 (01) 12-21
• 3 Donnelly LA, Morris AD, Frier BM. et al; DARTS/MEMO Collaboration. Frequency and predictors of hypoglycaemia in Type 1 and insulin-treated Type 2 diabetes: a population-based study. Diabet Med 2005; 22 (06) 749-755
• 4 Lopez JM, Annunziata K, Bailey RA, Rupnow MF, Morisky DE. Impact of hypoglycemia on patients with type 2 diabetes mellitus and their quality of life, work productivity, and medication adherence. Patient Prefer Adherence 2014; 8: 683-692
• 5 Liu S, Zhao Y, Hempe JM, Fonseca V, Shi L. Economic burden of hypoglycemia in patients with Type 2 diabetes. Expert Rev Pharmacoecon Outcomes Res 2012; 12 (01) 47-51
• 6 Williams SA, Shi L, Brenneman SK, Johnson JC, Wegner JC, Fonseca V. The burden of hypoglycemia on healthcare utilization, costs, and quality of life among type 2 diabetes mellitus patients. J Diabetes Complications 2012; 26 (05) 399-406
• 7 Seaquist ER, Anderson J, Childs B. et al. Hypoglycemia and diabetes: a report of a workgroup of the American Diabetes Association and the Endocrine Society. Diabetes Care 2013; 36 (05) 1384-1395
• 8 American Diabetes Association Professional Practice Committee. 6. Glycemic goals and hypoglycemia: standards of care in diabetes-2024. Diabetes Care 2024; 47 (Suppl. 01) S111-S125
• 9 Fisher SJ, Huang X, Pawaskar M. et al. Hypoglycemia in type 2 diabetes: understanding patients' and physicians' knowledge and experience. Endocrine 2018; 60 (03) 435-444
• 10 Beshyah SA, Sherif IH, Mustafa HE. et al. Patterns of clinical management of hypothyroidism in adults: an electronic survey of physicians from the Middle East and Africa. J Diab Endocr Pract 2021; 4: 75-82
• 11 Beshyah SA, Ali KF. Management of adrenal insufficiency: a survey of perceptions and practices of physicians from the Middle East and North Africa. J Diab Endocr Pract 2021; 4: 125-130
• 12 Beshyah SA, Khalil AB. Clinical practice patterns in managing thyroid nodules: the first survey from the Middle East and Africa. J Diab Endocr Pract 2021; 4: 167-174
• 13 Setji TL, Page C, Pagidipati N, Goldstein BA. Differences in achieving Hba1c goals among patients seen by endocrinologists and primary care providers. Endocr Pract 2019; 25 (05) 461-469
• 14 Liu H, Hou H, Yang M, Hou Y, Shan Z, Cao Y. The role of primary physician training in improving regional standardized management of diabetes: a pre-post intervention study. BMC Prim Care 2022; 23 (01) 51
• 15 Turchin A, Shubina M, Pendergrass ML. Relationship of physician volume with process measures and outcomes in diabetes. Diabetes Care 2007; 30 (06) 1442-1447
• 16 American Diabetes Association Professional Practice Committee. 6. Glycemic goals and hypoglycemia: standards of care in diabetes-2025. Diabetes Care 2025; 48 (1, Suppl 1): S128-S145
• 17 Davies MJ, Aroda VR, Collins BS. et al. Management of Hyperglycemia in Type 2 Diabetes, 2022. A consensus report by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD). Diabetes Care 2022; 45 (11) 2753-2786
• 18 Genere N, Sargis RM, Masi CM. et al. Physician perspectives on de-intensifying diabetes medications. Medicine (Baltimore) 2016; 95 (46) e5388
• 19 Bispo Júnior JP. Social desirability bias in qualitative health research. Rev Saude Publica 2022; 56: 101
• 20 Sousa VD, Rojjanasrirat W. Translation, adaptation and validation of instruments or scales for use in cross-cultural health care research: a clear and user-friendly guideline. J Eval Clin Pract 2011; 17 (02) 268-274