The current status of treatment‐related severe hypoglycemia in Japanese patients with diabetes mellitus: A report from the committee on a survey of severe hypoglycemia in the Japan Diabetes Society

Abstract

Despite great strides in pharmacotherapy for diabetes, there is increasing concern over the risk of hypoglycemia in patients with diabetes receiving pharmacotherapy as they become increasingly older. This has prompted the Japan Diabetes Society (JDS) to initiate a survey on the current status of severe hypoglycemia in clinical settings. In July 2015, following approval from the JDS Scientific Survey/Research Ethics Committee, the JDS extended an invitation to executive educators, who represented a total of 631 healthcare facilities accredited by the JDS for diabetes education, to participate in the proposed survey. Of these, those who expressed their willingness to participate in the survey were sent an application form required for obtaining ethical approval at these healthcare facilities and were then asked, following approval, to enter relevant clinical data on an unlinked, anonymous basis in a web‐based registry. The current survey was fully funded by the JDS Scientific Survey/Research Committee. A case registry (clinical case database) was launched after facility‐specific information (healthcare facility database) was collected from all participating facilities and after informed consent was obtained from all participating patients. With severe hypoglycemia defined as the “presence of hypoglycemic symptoms requiring assistance from another person to treat and preferably venous plasma glucose levels at onset/diagnosis of disease or at presentation clearly less than 60 mg/dL (capillary whole blood glucose, less than 50 mg/dL)”, the current survey was conducted between April 1, 2014 and March 31, 2015, during which facility‐specific information was collected from a total of 193 facilities with a total of 798 case reports collected from 113 facilities. Of the 193 respondent facilities, 149 reported having an emergency department as well, with the median number of patients who required emergency transportation services to reach these facilities totaling 4,962 annually, of which those with severe hypoglycemia accounted for 0.34% (17). The respondent facilities accommodated a total of 2,237 patients with severe hypoglycemia annually, with the number of patients thus accommodated being 6.5 patients per site. A total of 1,171 patients were admitted for severe hypoglycemia, with the number of patients thus admitted being 4.0 per site, who accounted for 52.3% of all patients visiting annually for severe hypoglycemia. A review of the 798 case reports collected during the survey revealed that 240, 480 and 78 patients had type 1 diabetes, type 2 diabetes, and other types of diabetes, respectively; those with type 2 diabetes were shown to be significantly older (median [interquartile range], 77.0 [68.0–83.0]) than those with type 1 diabetes (54.0 [41.0–67.0]) (P < 0.001); and the BMI was shown to be significantly higher for those with type 2 diabetes (22.0 [19.5–24.8] kg/m2) than for those with type 1 diabetes (21.3 [18.9–24.0] kg/m2) (P = 0.003). It was also found that the median estimated glomerular filtration ra...

Absolute risk of acute coronary syndrome after severe hypoglycemia: A population‐based 2‐year cohort study using the National Database in Japan

“…A retrospective cohort study in the USA reported annual severe hypoglycemia incidence proportions of 0.33 and 0.31% in 2014 and 2015, respectively 22 . A previous study also estimated that approximately 20,000 patients were transported annually to the emergency room for severe hypoglycemia in Japan 36 . According to our data, 24,509 patients experienced severe hypoglycemic episodes annually (annual incidence proportion 0.30%), which was consistent with the results of previous studies 22,36 .…”

“…A previous study also estimated that approximately 20,000 patients were transported annually to the emergency room for severe hypoglycemia in Japan 36 . According to our data, 24,509 patients experienced severe hypoglycemic episodes annually (annual incidence proportion 0.30%), which was consistent with the results of previous studies 22,36 . Third, we could not review the detailed medical records of each patient, including bodyweight, smoking history and family history.…”

Retrospective analysis of medical costs and resource utilization for severe hypoglycemic events in patients with type 2 diabetes in Japan

“…Finally, the costs related to emergency transportation and other indirect costs were not captured. Namba et al . estimated that approximately 20,000 patients were transported to hospitals by ambulance per year in Japan; therefore, it is expected that in Japan a significant number of patients were transported to hospitals by ambulance.…”

“…Finally, the costs related to emergency transportation and other indirect costs were not captured. Namba et al 25 estimated that approximately 20,000 patients were transported to hospitals by ambulance per year in Japan; therefore, it is expected that in Japan a significant number of patients were transported to hospitals by ambulance. Considering that outpatient visits for SHEs could have been underestimated and that ambulance costs were not included, further studies are required to clarify the overall direct costs of SHEs in Japan.…”

Humanistic and economic burden of cardiovascular disease related comorbidities and hypoglycaemia among patients with type 2 diabetes in Japan

“…Several commonly used glucose lowering agents may introduce the side-effect of hypoglycaemia. A survey done by the Japan Diabetes Society (JDS) found that the majority of patients with T2D who experienced severe hypoglycaemia were insulin (60.8%) or sulfonylurea (33.1%) users [11], both of which are widely used in Japan. Additionally, epidemiologic evidence from a meta-analysis showed that severe hypoglycaemia is strongly associated with CVD among patients with T2D [12].…”