High rates of severe hypoglycemia among African American patients with diabetes: the surveillance, prevention, and Management of Diabetes Mellitus (SUPREME-DM) network

Abstract

Aims Seven-year surveillance study (2005–2011) to evaluate race/ethnic differences in the trends in rates of severe hypoglycemia (SH) in a population of insured, at-risk adults with diabetes. Methods SH events were identified via any primary or principal diagnosis from emergency department or inpatient encounters among African American, Asian, Latino and White adult diabetes patients treated with insulin or secretagogues (Sulfonylureas or Meglitinides), receiving care from integrated healthcare delivery systems across the United States. We calculated age- and sex-standardized annual SH rates and average annual percent change (AAPC) in SH rates. Results Annual SH rates ranged from 1.8% to 2.1% during this 7-year observation period (2,200,471 person-years). African Americans had consistently higher SH rates compared with Whites, while Latinos and Asians had consistently lower rates compared with Whites in each of the 7 years (all p<0.01). The trend increased significantly only among African Americans (AAPC = +4.3%; 95% CI: +2.1, +6.5%); in the other groups, the AAPC was not significantly different from zero. Conclusions Surveillance efforts should monitor the racial/ethnic-specific rates. The factors underlying substantially higher rates of hypoglycemia in African Americans should be evaluated. Clinically and culturally-appropriate strategies to reduce the risk of SH need to be developed and tested.

Risk Factors for Severe Hypoglycemia in Black and White Adults With Diabetes: The Atherosclerosis Risk in Communities (ARIC) Study

“…Our finding that blacks are at higher risk of hypoglycemia is consistent with those of prior studies (6,8–10,27) demonstrating major racial disparities in hypoglycemia risk. In sensitivity analyses, we found that the observed racial disparities were not entirely explained by the available metrics of socioeconomic status.…”

“…The incidence rates of severe hypoglycemia in our study (range in demographic groups 6–25/1,000 person-years) are similar to other studies of persons with type 2 diabetes and attest to the high burden of hypoglycemia in the community (4,10,14,24). Our results extend the evidence for risk factors previously identified in the literature.…”

“…Fourth, within the ARIC Study, race and geographic location are conflated: blacks and whites were recruited at different study sites in the ARIC Study, with overlap only at the Forsyth County study site. Thus, although we cannot be certain that the difference between blacks and whites is due to racial disparities and not geographic differences, other studies (6,8–10) have found similarly higher rates among African Americans compared with whites. Fifth, we only had single baseline measurements of the risk factors examined here and cannot evaluate how changes in risk factors, including diabetes medications, during follow-up may have affected hypoglycemia risk.…”

“…There are also substantial racial disparities in rates of hypoglycemia (8–10). Blacks have approximately twofold higher rates of severe hypoglycemia, and this excess risk persists after multivariate adjustment, suggesting that other factors may contribute to hypoglycemia risk in blacks (6).…”

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

“…Observational analyses conducted in North America reported higher rates of severe hypoglycaemia and hospital admission for hypoglycaemia in African-Americans, compared with other ethnicities [14,[21][22][23][24]. Moreover, a recent study in England has confirmed a different risk of hypoglycaemia in people with diabetes of diverse ethnicity, reporting a 60% higher risk of hospital admission for severe hypoglycaemia in people of Caribbean descent, compared with those of European descent, accounting for socioeconomic differences [25].…”