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Cited by 229Diabetes Management and ResearchDiabetes Treatment and ManagementPatient Safety and Medication Errors

Hypoglycemia among patients with type 2 diabetes: epidemiology, risk factors, and prevention strategies

Open access
Silbert, Richard, Salcido-Montenegro, Alejandro, Rodriguez-Gutierrez, Rene, Katabi, Abdulrahman, McCoy, Rozalina G.·2018·Current Diabetes Reports
DOI 10.1007/s11892-018-1018-0PMC PMC6117835
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Abstract

Purpose of ReviewHypoglycemia is the most common and often treatment-limiting serious adverse effect of diabetes therapy. Despite being potentially preventable, hypoglycemia in type 2 diabetes incurs substantial personal and societal burden. We review the epidemiology of hypoglycemia in type 2 diabetes, discuss key risk factors, and introduce potential prevention strategies.Recent FindingsReported 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.SummaryHypoglycemia 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.

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  • Other notable clinical and biological risk factors for hypoglycemia are very young age, older age, multimorbidity, cognitive impairment, chronic kidney disease and kidney failure, CVD, depression, neuropathy, and gastroparesis.

    “Other notable clinical and biological risk factors for hypoglycemia are very young age, older age, multimorbidity, cognitive impairment, chronic kidney disease and kidney failure, CVD, depression, neuropathy, and gastroparesis (94,95,117).”

    From 6. Glycemic Goals, Hypoglycemia, and Hyperglycemic Crises: Standards of Care in Diabetes-2026. (2026) · cites this paper as [94]

    The Risk Factors for Hypoglycemia section identifies older age, multimorbidity, kidney disease, cognitive impairment, cardiovascular disease, and depression as risk factors; the Preventing Hypoglycemia section also identifies advanced kidney disease as a high-risk condition. Our copy does not identify very young age, neuropathy, or gastroparesis as risk factors. Page numbers are unavailable in the indexed copy. (LLM, conf=0.88)

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  • Individuals at risk for hypoglycemia are those treated with insulin, sulfonylureas, or meglitinides; clinically significant hypoglycemia is rare among individuals taking other diabetes medication classes.

    “Individuals at risk for hypoglycemia are those treated with insulin, sulfonylureas, or meglitinides; clinically significant hypoglycemia is rare among individuals taking other diabetes medication classes (94,95).”

    From 6. Glycemic Goals, Hypoglycemia, and Hyperglycemic Crises: Standards of Care in Diabetes-2026. (2026) · cites this paper as [94]

  • Female sex has also been found to be an independent risk factor for hypoglycemia in multiple studies, although the mechanisms of this relationship are unclear and require further research.

    “Female sex has also been found to be an independent risk factor for hypoglycemia in multiple studies, although the mechanisms of this relationship are unclear and require further research (94).”

    From 6. Glycemic Goals, Hypoglycemia, and Hyperglycemic Crises: Standards of Care in Diabetes-2026. (2026) · cites this paper as [94]

    The Risk Factors for Hypoglycemia section discusses age, treatment, comorbidities and social determinants, but does not identify female sex as an independent risk factor. Searches for female sex, women, and sex as an independent predictor found no passage addressing the claimed association or its mechanisms. (LLM, conf=0.73)

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Research works printed but not linked: 1

  1. [101]Malkani S, Kotwal A. Frequency and Predictors of Self-Reported Hypoglycemia in Insulin-Treated Diabetes. J Diabetes Res. 2017; 2017: 7425925. doi: 10.1155/2017/7425925. 28913365 PMC5585629 · DOI

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Authors
Silbert, R., Salcido-Montenegro, A., Rodriguez-Gutierrez, R., Katabi, A., & McCoy, R. G.
Affiliations
Mayo Clinic (US)
Corresponding author
McCoy, Rozalina G.
ORCID
Venue
Current Diabetes Reports
Publisher
Springer Science and Business Media LLC
Published
2018-06-21
Volume
18
Issue
8
Pages
53-53
ISSN
  • 1534-4827 (ISSN-L)
  • 1539-0829
DOI
10.1007/s11892-018-1018-0
PMC
PMC6117835
OpenAlex
W2809031508
Semantic Scholar
d6d2b9f681259ecdf86d479f18c51145da848f3e
Cited by
229
References
126
Citations by year
2026: 15 · 2025: 34 · 2024: 42 · 2023: 47 · 2022: 36 · 2021: 24 · 2020: 15 · 2019: 14 · 2018: 1 · 2013: 1
FWCI
2.08
Type
journal article
Language
en
Open access
Licence
www.springer.com/tdm (tdm)
Locations
  • Current Diabetes Reports (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
Funders
  • Mayo Clinic
  • National Institute of Diabetes and Digestive and Kidney Diseases (K23DK114497)
Topics
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
  • Health Sciences › Health Professions › Emergency Medical Services › Patient Safety and Medication Errors
Keywords
hypoglycemia, type 2 diabetes, hypoglycemia risk factors, hypoglycemia prevention, insulin therapy, sulfonylureas, food insecurity, fasting, diabetes duration, comorbidities, clinical decision support, treatment deintensification, diabetes self-management, diabetes technology, multidisciplinary care
MeSH terms
Blood Glucose, Diabetes Mellitus, Type 2, Humans, Hypoglycemia, Risk Factors, Randomized Controlled Trials as Topic

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