Severe Hypoglycemia Is a Serious Complication and Becoming an Economic Burden in Diabetes

Abstract

BackgroundThe prevalence of hypoglycemia is increasing due to the growing incidence of diabetes and the latest strict guidelines for glycated hemoglobin (HbA1c) levels under 7%. This study examined the clinical characteristics, causal factors, and medical costs of severely hypoglycemic patients in an emergency room (ER) of Uijeongbu St. Mary's Hospital.MethodsThe study consisted of a retrospective analysis of the characteristics, risk factors, and medical costs of 320 severely hypoglycemic patients with diabetes who presented to an ER of Uijeongbu St. Mary's Hospital from January 1, 2006 to December 31, 2009.ResultsMost hypoglycemic patients (87.5%, 280/320) were over 60 years old with a mean age of 69.5±10.9 years and a mean HbA1c level of 6.95±1.46%. Mean serum glucose as noted in the ER was 37.9±34.5 mg/dL. Renal function was decreased, serum creatinine was 2.0±2.1 mg/dL and estimated glomerular filtration rate (eGFR) was 48.0±33.6 mL/min/1.73 m2. In addition, hypoglycemic patients typically were taking sulfonylureas or insulin and a variety of other medications, and had a long history of diabetes.ConclusionSevere hypoglycemia is frequent in older diabetic patients, subjects with low HbA1c levels, and nephropathic patients. Therefore, personalized attention is warranted, especially in long-term diabetics with multiple comorbidities who may not have been properly educated or may need re-education for hypoglycemia.

Hazardous factors besides infection in hypoglycemia

“…In a Korean report conducted in 2012, the mean age of hypoglycemic patients was 69.5 years, which is comparable with the current study (age, 70.5 years) (1). In the present study, the mean age of the group of hypoglycemic patients with concurrent infection was 72.7 years, which was five years older than patients without infection (7,8).…”

“…Furthermore, in concurrent UTI patients, missed meals exerted a reduced effect. Impaired renal function and hepatic diseases are comorbidities that are associated with hypoglycemia (1,3). In the current study, 62.4% of the hypoglycemic patients had impaired renal function and 26.3% of patients had ARF at the time of the hypoglycemic episode.…”

“…Common causes are concurrent infection, a lack of adequate food intake, chronic alcohol abuse, interactions among medications (as a result of polypharmacy), exhaustion from physical exertion and overdose of medications (insulin/oral hypoglycemic agent). In the past, there have been numerous articles describing the etiologies of hypoglycemia, including old age, lack of recent food intake, infection, chronic renal insufficiency, liver diseases and recurrent hypoglycemic episodes (1)(2)(3). Hypoglycemia was investigated in the present study via a retrospective review of records from December 2009 to February 2012 at a tertiary teaching medical center in northern Taiwan.…”

Association Between Hypoglycemia and Fall-Related Events in Type 2 Diabetes Mellitus: Analysis of a U.S. Commercial Database

“…8 A Korean study reported costs ranging from $135.50 to $1,391.00 per episode of severe hypoglycemia. 9 Swedish studies report the direct costs of hypoglycemia per patient being $12.90 for a 1-month period, while the indirect costs are $14.10 for a 1-month period, with the total cost (in base case) of hypoglycemia in Sweden being approximately €4,250,000 (~$5.74 million) per year. 10,11 In addition to an increase in health care utilization and costs, hypoglycemia also leads to decline in the quality of life of the patients.…”

Should Sulfonylureas Remain an Acceptable First-Line Add-on to Metformin Therapy in Patients With Type 2 Diabetes? Yes, They Continue to Serve Us Well!

“…Increased risk of hypoglycemia occurs in patients with chronic renal impairment and the elderly. And the most common causal factors were poor nutrition or a missed meal (7). Hence, it is appropriate that glyburide be avoided in these population groups.…”