Hypoglycemia Among Patients with Type 2 Diabetes: Epidemiology, Risk Factors, and Prevention Strategies

Abstract

Reported rates of hypoglycemia in type 2 diabetes vary widely as there is marked heterogeneity in how hypoglycemia is defined, measured, and reported. In randomized controlled trials, rates of severe hypoglycemia ranged from 0.7 to 12 per 100 person-years. In observational studies, hospitalizations or emergency department visits for hypoglycemia were experienced by 0.2 (patients treated without insulin or sulfonylurea) to 2.0 (insulin or sulfonylurea users) per 100 person-years. Patient-reported hypoglycemia is much more common. Over the course of 6 months, 1-4% non-insulin users reported need for medical attention for hypoglycemia; 1-17%, need for any assistance; and 46-58%, any hypoglycemia symptoms. Similarly, over a 12-month period, 4-17% of insulin-treated patients reported needing assistance and 37-64% experienced any hypoglycemic symptoms. Hypoglycemia is most common among older patients with multiple or advanced comorbidities, patients with long diabetes duration, or patients with a prior history of hypoglycemia. Insulin and sulfonylurea use, food insecurity, and fasting also increase hypoglycemia risk. Clinical decision support tools may help identify at-risk patients. Prospective trials of efforts to reduce hypoglycemia risk are needed, and there is emerging evidence supporting multidisciplinary interventions including treatment de-intensification, use of diabetes technologies, diabetes self-management, and social support. Hypoglycemia among patients with type 2 diabetes is common. Patient-centered multidisciplinary care may help proactively identify at-risk patients and address the multiplicity of factors contributing to hypoglycemia occurrence.

Incidence of severe hypoglycemia and its association with serum adiponectin in Japanese patients with type 1 and insulin‐treated type 2 diabetes: The Fukuoka Diabetes Registry

“…Procedure Combination database was reported to be 0.004 per patient-year in people with type 2 diabetes treated with oral hypoglycemic agents and/or insulin 18 , which was also very low. There were many studies that investigated risk factors for severe hypoglycemia in patients with type 1 or type 2 diabetes 1,2,19 . The risk factors include advanced age, long duration of diabetes, tighter glycemic control, large consumption of alcohol, history of severe hypoglycemia, unawareness of hypoglycemia, CKD, autonomic neuropathy, cognitive impairment, depression and so on.…”

“…Although new antidiabetic drugs with fewer hypoglycemic adverse effects have been introduced into treatment for patients with type 2 diabetes mellitus, insulin therapy is essential for those with type 1 and insulin-deficient type 2 diabetes. Therefore, the risk for developing hypoglycemia is inevitable in insulin-treated patients, and severe hypoglycemia might be fatal through hypoglycemic encephalopathy or accident trauma 1,2 . In addition, episodes of severe hypoglycemia are associated with increased risks of cardiovascular disease and mortality in patients with type 2 diabetes 3,4 .…”

“…In addition, episodes of severe hypoglycemia are associated with increased risks of cardiovascular disease and mortality in patients with type 2 diabetes 3,4 . The incidence of severe hypoglycemia and its risk factors have been widely investigated 1,2 , and recent surveys in Europe showed that the incidence of severe hypoglycemia declined in those with type 1 diabetes 5 and older adults with type 2 diabetes 6 .…”

“…Risk factors for severe hypoglycemia include long-standing diabetes, prior hypoglycemic events, diabetic complications, comorbid conditions, excessive alcohol intakes and so on 1,2 . Furthermore, the susceptibility to severe hypoglycemia might be affected by insulin sensitivity.…”

Association of Cumulative Multimorbidity, Glycemic Control, and Medication Use With Hypoglycemia-Related Emergency Department Visits and Hospitalizations Among Adults With Diabetes

“…Multiple factors increase the risk of severe hypoglycemia, including older age, a variety of health conditions, social determinants of health, sulfonylurea or insulin therapy, and intensive glycemic control. 7 Clinical practice guidelines recommend that glycemic targets be relaxed and treatment regimens be deintensified in patients who are older or have health conditions or social situations that increase their risk of hypoglycemia. [8][9][10][11][12][13] Yet, the contributions of patient-, disease-, and treatment-related factors to severe hypoglycemia are not well defined.…”