Epidemiological, Social and Economic Burden of Severe Hypoglycaemia in Patients with Diabetes Mellitus in Portugal: A Structured Literature Review

Abstract

Introduction The aim of this review was to identify and review studies reporting on the epidemiological, social and economic impact associated with severe hypoglycaemia (SH) in people with diabetes mellitus (DM) in Portugal. Methods A structured literature search was carried out in PubMed and Embase using a predefined selection criterion. Studies published in either Portuguese or English, between January 2010 and February 2021 were deemed eligible for inclusion. Results Twelve studies including adults (aged ≥ 18 years) with type 1 and/or type 2 diabetes mellitus (T1DM/T2DM) were eligible for inclusion. Epidemiological estimates varied according to the setting and type of data source used. The proportion of patients who experienced ≥ 1 SH episode (SHE) in the previous 6–12 months varied from 3.1% in adults with T2DM to 36.8% in adults with T1DM. In adults with T2DM the prevalence in a community-based study was highest in the insulin and secretagogue combination treated group (9.1%), while in an emergency department setting prevalence was highest in the insulin-based therapy group and the oral hypoglycaemic agent without secretagogues group (32.0% and 20.0%, respectively). The prevalence of SH in other studies in patients with DM ranged from 0.1% (emergency department) to 18.1% (hospital ward). Patients treated with secretagogues had the highest rates of hospitalisations. In patients with T1DM, the annual rate of SHE was higher in those with impaired hypoglycaemia awareness than in those with intact awareness. Mean total cost (direct and indirect) per SHE ranged from €1493.00 in patients with T2DM treated in an emergency setting to €2608.51 in patients with T1DM who were hospitalised. Conclusion Hypoglycaemic events, especially SHE, have a significant effect on the life of persons living with DM and their caregivers. Studies show that the prevalence of this acute complication of diabetes is not negligible. In addition to the negative impact on the quality of life, the burden of SHE in Portugal translates into a significant impact on the global health expenditure. Supplementary Information The online version contains supplementary material available at 10.1007/s13300-022-01358-1.

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“…About 422 million people worldwide have T2DM, most living in low–middle-income countries, and 1.5 million deaths are directly attributed to diabetes yearly [ 18 ]. In Portugal, the incidence of T2DM is much higher than in other types of diabetes [ 19 , 20 ]. Epidemiological studies show that Portugal (9.1%) is among the countries with the highest rates in Europe, alongside Turkey (14.5%), Spain (10.3%), Andorra (9.7%), and Serbia (9.1%) [ 17 ].…”

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“…In this perspective, the literature reiterates the association of social determinants with hospitalizations ( 5 ) and complications ( 6 ) due to DM. However, there is lack of research studies evaluating these aspects as predictors of death due to DM.…”