Surveillance of hypoglycemia-limitations of emergency department and hospital utilization data
Open accessAbstract
This study examines the proportion of all severe hypoglycemic events that are captured by surveillance based on health care utilization alone among pharmacologically treated patients with diabetes.
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Nevertheless, epidemiologic studies reveal a substantial burden of hypoglycemia-related hospital utilization in the community.
“Nevertheless, they reveal a substantial burden of hypoglycemia-related hospital utilization in the community (87)(88)(89)(90).”
From 6. Glycemic Goals, Hypoglycemia, and Hyperglycemic Crises: Standards of Care in Diabetes-2026. (2026) · cites this paper as [87]
The Discussion describes hypoglycemia-related ED visits or hospitalization as rare, at approximately 0.8% annually, rather than a substantial burden of hospital utilization. The Results report documented ED or hospital utilization for 102 of 13,359 patients; the paper emphasizes that utilization data miss most severe hypoglycemic events. (LLM, conf=0.85)
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Experimental — accuracy not yet measuredEpidemiologic studies of hypoglycemia predominantly rely on claims data to assess hypoglycemia-related hospitalizations and emergency department visits.
“Epidemiologic studies of hypoglycemia predominantly rely on claims data to assess hypoglycemia-related hospitalizations and emergency department visits (87)(88)(89)(90).”
From 6. Glycemic Goals, Hypoglycemia, and Hyperglycemic Crises: Standards of Care in Diabetes-2026. (2026) · cites this paper as [87]
The opening passage says U.S. hypoglycemia surveillance has relied on EMR or administrative claims data from emergency department visits and hospital admissions. It supports the use of claims data for these outcomes, but does not establish that epidemiologic studies predominantly rely on claims rather than EMR data. (LLM, conf=0.84)
Experimental — accuracy not yet measuredThese studies do not capture the level 1 and level 2 hypoglycemia that represent the vast majority of hypoglycemic events, and they also substantially underestimate level 3 hypoglycemia.
“These studies do not capture the level 1 and level 2 hypoglycemia that represent the vast majority of hypoglycemic events, and they also substantially underestimate level 3 hypoglycemia (87,91,92).”
From 6. Glycemic Goals, Hypoglycemia, and Hyperglycemic Crises: Standards of Care in Diabetes-2026. (2026) · cites this paper as [87]
The Discussion reports that ED and hospital surveillance captures only about 5% of self-reported severe hypoglycemic events among pharmacologically treated patients with diabetes, supporting substantial underestimation of level 3 events. The paper does not assess level 1 or level 2 events or establish that they constitute the vast majority of all hypoglycemic events. (LLM, conf=0.87)
Experimental — accuracy not yet measuredStudies of rates of level 3 hypoglycemia that rely on claims data for hospitalization, emergency department visits, and ambulance use substantially underestimate rates of level 3 hypoglycemia.
“Studies of rates of level 3 hypoglycemia that rely on claims data for hospitalization, emergency department visits, and ambulance use substantially underestimate rates of level 3 hypoglycemia (87) yet reveal a high burden of hypoglycemia in adults over 60 years of age in the community (88).”
From 6. Glycemic Targets: <i>Standards of Care in Diabetes—2023</i> (2023) · cites this paper as [87]
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References 4 · Cited by 73
- Authors
- Karter, A. J., Moffet, H. H., Liu, J. Y., & Lipska, K. J.
- Affiliations
- Kaiser Permanente (US)
- Yale University (US)
- Corresponding author
- Karter, Andrew J.
- Venue
- JAMA Internal Medicine
- Publisher
- American Medical Association (AMA)
- Published
- 2018-07-01
- Volume
- 178
- Issue
- 7
- Pages
- 987
- ISSN
- 2168-6106 (ISSN-L)
- PMC
- PMC6033620
- OpenAlex
- W2800237089
- Semantic Scholar
- 55a1f9f9958fe51cdbfa5746f1e67112e68d173d
- Cited by
- 73
- References
- 4
- Citations by year
- 2026: 8 · 2025: 8 · 2024: 5 · 2023: 14 · 2022: 7 · 2021: 14 · 2020: 7 · 2019: 6 · 2018: 4
- FWCI
- 6.16
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- JAMA Internal Medicine (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institute on Aging (K23AG048359, P30AG021342)
- National Institute of Diabetes and Digestive and Kidney Diseases (R01DK103721, R01DK065664, P30DK092924)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
- Health Sciences › Health Professions › Emergency Medical Services › Patient Safety and Medication Errors
- Life Sciences › Pharmacology, Toxicology and Pharmaceutics › Toxicology › Pharmacovigilance and Adverse Drug Reactions
- Keywords
- hypoglycemia, diabetes mellitus, surveillance (medicine), health care utilization data, emergency department visits, hospitalization, underreporting
- MeSH terms
- California, Emergency Service, Hospital, Female, Hospitalization, Humans, Hypoglycemia, Hypoglycemic Agents, Male, Middle Aged, Patient Acceptance of Health Care, Population Surveillance, Surveys and Questionnaires
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