Global burden of hypoglycaemia-related mortality in 109 countries, from 2000 to 2014: an analysis of death certificates

Abstract

Aims/hypothesis In the context of increasing prevalence of diabetes in elderly people with multimorbidity, intensive glucose control may increase the risk of severe hypoglycaemia, potentially leading to death. While rising trends of severe hypoglycaemia rates have been reported in some European, North American and Asian countries, the global burden of hypoglycaemia-related mortality is unknown. We aimed to investigate global differences and trends of hypoglycaemia-related mortality. Methods We used the WHO mortality database to extract information on death certificates reporting hypoglycaemia or diabetes as the underlying cause of death, and the United Nations demographic database to obtain data on mid-year population estimates from 2000 to 2014. We calculated crude and age-standardised proportions (defined as number of hypoglycaemia-related deaths divided by total number of deaths from diabetes [i.e. the sum of hypoglycaemia-and diabetes-related deaths]) and rates (hypoglycaemia-related deaths divided by mid-year population) of hypoglycaemia-related mortality and compared estimates across countries and over time.Results Data for proportions were extracted from 109 countries (31 had data from all years analysed [2000][2001][2002][2003][2004][2005][2006][2007][2008][2009][2010][2011][2012][2013][2014] available). Combining all countries, the age-standardised proportion of hypoglycaemia-related deaths was 4.49 (95% CI 4.44, 4.55) per 1000 total diabetes deaths. Compared with the overall mean, most Central American, South American and (mainly) Caribbean countries reported higher proportions (five more age-standardised hypoglycaemia-related deaths per 1000 total diabetes deaths in Chile, six in Uruguay, 11 in Belize and 22 in Aruba), as well as Japan (11 more age-standardised hypoglycaemia-related deaths per 1000 total diabetes deaths). In comparison, lower proportions were noted in most European countries, the USA, Canada, New Zealand and Australia. For countries with data available for all years analysed, trend analysis showed a 60% increase in hypoglycaemia-related deaths until 2010 and stable trends onwards. Rising trends were most evident for Argentina, Brazil, Chile, the USA and Japan. Data for rates were available for 105 countries (30 had data for all years analysed [2000][2001][2002][2003][2004][2005][2006][2007][2008][2009][2010][2011][2012][2013][2014] available). Combining all countries, the age-standardised hypoglycaemia-related death rate was 0.79 (95% CI 0.77, 0.80) per 1 million person-years. Most Central American, South American and Caribbean countries similarly reported higher rates of hypoglycaemia-related death, whilst virtually all European countries, the USA, Canada, Japan, New Zealand and Australia reported lower rates compared with the overall mean. Age-standardised rates were very low for most countries (lower than five per 1 million person-years in 89.5% of countries), resulting in small absolute differences among countries. As noted with the proportions analysis, trend analysis sho...

Selectivity of beta-blockers, cardiovascular and all-cause mortality in people with hypoglycaemia: An observational study

“…The increasing prevalence of aging, multimorbid patients with diabetes has resulted in global increasing trends of hypoglycaemia and hypoglycaemia-related mortality [30,31]; approaches to reduce the burden of hypoglycaemia-related death are therefore warranted. Our data indicate that non-selective beta-blockers may increase the risk of mortality in patients without hypoglycaemia; conversely, in patients with hypoglycaemia, there was no evidence of an increased risk for nonselective beta-blockers and a potentially reduced risk for beta1-selective beta-blockers.…”

Diabetes in developing countries

“…Morbidity and mortality due to hypoglycemia are important causes of concern due to poor health education, illiteracy, a lack of medical facilities, and intermittent or prolonged religious fasting . Treatment of diabetic foot remains most challenging of all complications, particularly in underprivileged and rural‐based populations, because of poor awareness, a lack of trained podiatrists, a delay in seeking treatment, and treatment expenses .…”

Hypoglycemia during Short-Term Intensive Insulin Therapy and Its Association with Long-Term Glycemic Remission in Patients with Newly Diagnosed Type 2 Diabetes

“…Hypoglycemia is classified into three levels based on the standard for hypoglycemia suggested by the recent American Diabetes Association (ADA) guideline [13], i.e., hypoglycemia alert value (mild hypoglycemia), clinically significant hypoglycemia (moderate hypoglycemia), and severe hypoglycemia. Severe hypoglycemia and clinically significant hypoglycemia are associated with an increased risk of macrovascular events, microvascular disease, and all-cause death [14][15][16][17][18].…”