The DOI matches its Crossref record; 126 of the 126 references it cites were found in a registry or an index.
Hypoglycemia Among Patients with Type 2 Diabetes: Epidemiology, Risk Factors, and Prevention Strategies
Open accessAbstract
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 (94,95,117).”
From 6. Glycemic Goals, Hypoglycemia, and Hyperglycemic Crises: Standards of Care in Diabetes-2026. (2026) · cites this paper as [94]
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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 (94,95).”
From 6. Glycemic Goals, Hypoglycemia, and Hyperglycemic Crises: Standards of Care in Diabetes-2026. (2026) · cites this paper as [94]
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“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]
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Citations
Cites
Empagliflozin, Cardiovascular Outcomes, and Mortality in Type 2 Diabetes
Zinman, B., Wanner, C., Lachin, J. M., Fitchett, D., Bluhmki, E., Hantel, S., Mattheus, M., Devins, T., Johansen, O. E., Woerle, H. J., et al. (2015) · New England Journal of Medicine · doi:10.1056/nejmoa1504720 · Cited by 12,315 · cited 3×
“…requiring third-party assistance occurred in 1.3% of empaglifozin-treated patients (vs. 1.5% in placebo group; median 3.1 years of observation), [34] 2.4% of liraglutide-treated patients (vs. 3.3% in placebo group; median 3.8 years of observation), [36] 2.1% of saxagliptin-treated patients (vs.…”
InfluentialTurner, R. C., Fox, C., Matthews, McElroy, H. H., Cull, C. A., Holman, R. R., Neil, P., Hadden, D. R., Wright, D., Manley, E., et al. (1998) · The Lancet · Cited by 8,419
Effects of Intensive Glucose Lowering in Type 2 Diabetes
(2008) · New England Journal of Medicine · doi:10.1056/nejmoa0802743 · Cited by 7,888
Canagliflozin and Cardiovascular and Renal Events in Type 2 Diabetes
Neal, B., Perkovic, V., Mahaffey, K. W., de Zeeuw, D., Fulcher, G., Erondu, N., Shaw, W., Law, G., Desai, M., & Matthews, D. R. (2017) · New England Journal of Medicine · doi:10.1056/nejmoa1611925 · Cited by 7,830
Liraglutide and Cardiovascular Outcomes in Type 2 Diabetes
Marso, S. P., Daniels, G. H., Brown-Frandsen, K., Kristensen, P., Mann, J. F. E., Nauck, M. A., Nissen, S. E., Pocock, S., Poulter, N. R., Ravn, L. S., et al. (2016) · New England Journal of Medicine · doi:10.1056/nejmoa1603827 · Cited by 7,629 · cited 2×
“These trials include EMPA-REG OUTCOME (empagliflozin),[34] CANVAS (canagliflozin),[35] LEADER (liraglutide),[36] SAVOR-TIMI 53 (saxagliptin),[37] TECOS (sitagliptin),[38] EXAMINE (alogliptin),[39] ELIXA (lixisenatide),[40] SUSTAIN-6 (semaglutide),[41] and DEVOTE (insulin degludec).”
InfluentialIntensive blood glucose control and vascular outcomes in patients with type 2 diabetes
(2008) · New England Journal of Medicine · doi:10.1056/nejmoa0802987 · Cited by 7,397
Semaglutide and Cardiovascular Outcomes in Patients with Type 2 Diabetes
Marso, S. P., Bain, S. C., Consoli, A., Eliaschewitz, F. G., Jódar, E., Leiter, L. A., Lingvay, I., Rosenstock, J., Seufert, J., Warren, M. L., et al. (2016) · New England Journal of Medicine · doi:10.1056/nejmoa1607141 · Cited by 6,900 · cited 2×
“These trials include EMPA-REG OUTCOME (empagliflozin),[34] CANVAS (canagliflozin),[35] LEADER (liraglutide),[36] SAVOR-TIMI 53 (saxagliptin),[37] TECOS (sitagliptin),[38] EXAMINE (alogliptin),[39] ELIXA (lixisenatide),[40] SUSTAIN-6 (semaglutide),[41] and DEVOTE (insulin degludec).”
InfluentialGlucose control and vascular complications in veterans with type 2 diabetes
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Cited by
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6. Glycemic Goals and Hypoglycemia: Standards of Care in Diabetes—2024
ElSayed, N. A., Aleppo, G., Bannuru, R. R., Bruemmer, D., Collins, B. S., Ekhlaspour, L., Hilliard, M. E., Johnson, E. L., Khunti, K., Lingvay, I., et al. (2023) · Diabetes Care · doi:10.2337/dc24-s006 · Cited by 574
Self-citation6. Glycemic Goals and Hypoglycemia: Standards of Care in Diabetes—2025
American Diabetes Association Professional Practice Committee, ElSayed, N. A., McCoy, R. G., Aleppo, G., Balapattabi, K., Beverly, E. A., Briggs Early, K., Bruemmer, D., Echouffo-Tcheugui, J. B., Ekhlaspour, L., et al. (2025) · Diabetes Care · doi:10.2337/dc25-s006 · Cited by 440
Self-citationBenefits and harms of intensive glycemic control in patients with type 2 diabetes
Rodriguez-Gutierrez, R., Gonzalez-Gonzalez, J. G., Zuñiga-Hernandez, J. A., & McCoy, R. G. (2019) · BMJ · doi:10.1136/bmj.l5887 · Cited by 152
Self-citationFood Insecurity and Cardiometabolic Conditions: a Review of Recent Research
Te‐Vazquez, J., Feng, S. N., Orr, C. J., & Berkowitz, S. A. (2021) · Current Nutrition Reports · doi:10.1007/s13668-021-00364-2 · Cited by 150
McCoy, R. G., Lipska, K. J., Van Houten, H. K., & Shah, N. D. (2020) · JAMA Network Open · doi:10.1001/jamanetworkopen.2019.19099 · Cited by 141
Self-citation
Metadata
- Authors
- Silbert, R., Salcido-Montenegro, A., Rodriguez-Gutierrez, R., Katabi, A., & McCoy, R. G.
- Affiliations
- Mayo Clinic (US)
- Corresponding author
- McCoy, Rozalina G.
- Venue
- Current Diabetes Reports
- Published
- 2018-06-21
- Volume
- 18
- Issue
- 8
- Pages
- 53-53
- ISSN
- 1534-4827 (ISSN-L)
- 1539-0829
- 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
- FWCI
- 2.08
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- 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 › Medicine › Public Health, Environmental and Occupational Health › 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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