Objectives: HYPO G is an observational, cross-sectional disease registry carried out in 2018 in Morocco and in Tunisia. The primary objectives of HYPO G study were to evaluate the proportion of patients with hypoglycemia in people whose type 2 diabetes (T2DM) is inadequately controlled with basal insulin and with high risk of hypoglycemia and to describe the insulin therapeutic strategy in those patients. Methods: A total of 40 investigators (20 investigators in Tunisia and 20 from Morocco) were planned to participate in the HYPO G study. The targeted sample size for each country was 250 patients with diabetes treated with basal insulin and presenting a high risk of hypoglycemia. Data regarding demographic characteristics, glycemic control, diabetes related complications, type and frequency of hypoglycemic events in the last month as well as the type and dosing of the anti?diabetic therapy were collected. Results: Overall, 508 patients fulfilling the selection criteria were included (256 in Morocco and 252 in Tunisia). In Morocco, 54.7% of the study patients were females. Mean age of the study population was 60.4 � 10.3 years with mean body mass index (BMI) of 33.1 � 18.1 kg/m2. On the other hand, 48.4% of the study patients were females, the mean age of patients in Tunisia was 63.6 � 10.4 years with a mean BMI of 29.3 � 6.51 kg/m2. Within the last month, 90.6% of the Moroccan patients experienced hypoglycemia [95%CI: 87.1%-94.1%]. Severe hypoglycemic episodes were seen in 14.5% (95%CI: 11.0-19.7%) of the patients in Morocco. In reference to patients reporting hypoglycemia within the last month in Tunisia, the observed proportion was 73.0% [95%CI: 67.1%-78.4%]. Severe hypoglycemic events were described by 15.9% (95%CI: 11.6-21.0%) of the patients. Regarding insulin therapeutic strategy, in morocco, a change in the insulin treatment concerned 64.6% patients reporting a hypoglycemic event in the last month, at study entry, 80.9% of the study participants were using the basal regimen, Long acting basal analog insulin was used in 88.6% of them, at the end of the study, the basal regimen was still the most prescribed regimen 60.7% and basal insulin analogs were still the most prescribed type of insulin 68.7%, followed by Basal Plus-Bolus 34.7% and premixed insulin in 2.3% of study population. For Tunisia, the modification in the insulin treatment used seems to be higher in the Tunisian patients reporting a hypoglycemic event in the last month 71.2%, at study entry, 100% of the study participants were using the basal regimen, long acting basal analog insulin in 58.7%, and intermediate human insulin was used in 41.3% of them, and at the end of the study, the basal regimen was still the most prescribed regimen 90.5%, basal insulin analogs rise to 64.3%, and intermediate human insulin decreased to 33.3%, followed by Basal Plus-Bolus 8.4% and premixed insulin 1.2% of study population. Conclusions: This study tried to evaluate the proportion of patients who experience hypoglycemia and the pattern of care of people with type 2 diabetes on Basal insulin, in a population that is at high risk of hypoglycemia. It was found that in such patients, the occurrence of hypoglycemia was indeed very high as reported in the month prior to the time of enrollment. Besides the inherent risk factors, suboptimal management of insulin therapy, lack of self-measure of blood glucose and lack of education on disease management could further add to the risk of hypoglycemia. These factors should therefore be integrated in the therapeutic approach to ensure a better management of hypoglycemia in people with type 2 diabetes.

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