Low Socioeconomic Status is Associated with Increased Risk for Hypoglycemia in Diabetes Patients: The Diabetes Study of Northern California (DISTANCE)

Abstract

Background Social risk factors for hypoglycemia are not well understood. Methods Cross-sectional analysis from the DISTANCE study, a multi-language, ethnically-stratified random sample of adults in the Kaiser Permanente Northern California diabetes registry, conducted in 2005-2006 (response rate 62%). Exposures were income and educational attainment; outcome was patient report of severe hypoglycemia. To test the association, we used multivariable logistic regression to adjust for demographic and clinical factors. Results 14,357 patients were included. Reports of severe hypoglycemia were common (11%), and higher in low-income vs. high-income (16% vs. 8.8) and low-education vs. high-education (11.9% vs. 8.9%) groups. In multivariable analysis, incomes of less than $15,000 (OR 1.51 95%CI 1.19-1.91), $15,000-$24,999 (OR 1.57 95%CI 1.27-1.94), and high school or less education (OR 1.42, 95% CI 1.24-1.63) were associated with increased hypoglycemia, similar to insulin use (OR 1.44 95%CI 1.19-1.74). Conclusions Low income and educational attainment are important risk factors for hypoglycemia.

Racial and Ethnic Disparities in Adverse Drug Events: A Systematic Review of the Literature

“…Administrative claims data were the most common sources of primary ADE detection, used in 37.5 % (15/40) of studies [9][10][11][12][13][14][15][16][17][18][19][20][21][22][23]. Chart review was used as a primary ADE detection method in 35 % (14/40) of studies [8,[24][25][26][27][28][29][30][31][32][33][34][35][36], and survey or patient/ parent report was used in 27.5 % (11/40) of the studies [27,32,33,[37][38][39][40][41][42][43][44]. Direct documentation by research staff was used by three studies (7.5 %) [45][46][47].…”

“…American Indians were found to be at increased risk for hypoglycemia in the one study that analyzed this group separately. Two of the four studies that included Asians demonstrated them to be at increased risk compared to whites, with OR 1.28 (95 % CI 1.09-1.51) for report of hypoglycemia [37] and OR 1.15 (95 % CI 1.03-1.75) for acute hypoglycemia admissions [19]. One study found this group to be at decreased risk for diabetes agents-related ADEs, with 37.3 % of Asian participants reporting ever experiencing hypoglycemia, while over 50 % of the other racial or ethnic groups reported this outcome [40].…”

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

“…In the DISTANCE Study, ~11% of surveyed diabetes patients reported an SH event in the previous 12 months, while only ~0.5% of that cohort received an ED or inpatient diagnosis of SH. (Sarkar et al, 2010) Since it is unclear what factors led persons experiencing an SH event to receive medical attention in the ED or hospital, racial/ethnic patterns of self-reported SH(Berkowitz et al, 2014; Lipska, et al, 2013) may differ from SH diagnosed at a medical facility. Moreover, since we based findings on SH identified via primary or principal diagnoses, findings cannot be generalized to SH events that were secondary to other diagnoses.…”

Risk factors of severe hypoglycemia requiring medical assistance and neurological sequelae in patients with diabetes

“…[18] A limited number of studies have investigated the associations of these conditions with the influence of self-management variables and socioeconomic status. [9,19,20] Therefore, we investigated whether diabetes self-management, education, socioeconomic status, and known risk factors for severe hypoglycemia were associated with HMA compared to NSH. We also determined the predictors of severe hypoglycemia with neurological sequelae.…”