Severe Hypoglycemia Requiring Medical Intervention in a Large Cohort of Adults With Diabetes Receiving Care in U.S. Integrated Health Care Delivery Systems: 2005–2011
Open accessAbstract
OBJECTIVE: Appropriate glycemic control is fundamental to diabetes care, but aggressive glucose targets and intensive therapy may unintentionally increase episodes of hypoglycemia. We quantified the burden of severe hypoglycemia requiring medical intervention in a well-defined population of insured individuals with diabetes receiving care in integrated health care delivery systems across the U.S. RESEARCH DESIGN AND METHODS: This observational cohort study included 917,440 adults with diabetes receiving care during 2005 to 2011 at participating SUrveillance, PREvention, and ManagEment of Diabetes Mellitus (SUPREME-DM) network sites. Severe hypoglycemia rates were based on any occurrence of hypoglycemia-related ICD-9 codes from emergency department or inpatient medical encounters and reported overall and by age, sex, comorbidity status, antecedent A1C level, and medication use. RESULTS: Annual rates of severe hypoglycemia ranged from 1.4 to 1.6 events per 100 person-years. Rates of severe hypoglycemia were higher among those with older age, chronic kidney disease, congestive heart failure, cardiovascular disease, depression, and higher A1C levels, and in users of insulin, insulin secretagogues, or β-blockers (P < 0.001 for all). Changes in severe hypoglycemia occurrence over time were not clinically significant in the cohort as a whole but were observed in subgroups of individuals with chronic kidney disease, congestive heart failure, and cardiovascular disease. CONCLUSIONS: Risk of severe hypoglycemia in clinical settings is considerably higher in identifiable patient subgroups than in randomized controlled trials. Strategies that reduce the risk of hypoglycemia in high-risk patients are needed.
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In T2D, advanced CKD is a risk factor for hypoglycemia.
“In T2D, advanced CKD is a risk factor for hypoglycemia (29,79) and, when possible, drugs that control glycemia without increasing risk of hypoglycemia are preferred.”
From Diabetes management in chronic kidney disease: a consensus report by the American Diabetes Association (ADA) and Kidney Disease: Improving Global Outcomes (KDIGO) (2022) · cites this paper as [79]
The Results report substantially higher rates of severe hypoglycemia in patients with CKD than in those without it. However, the paper does not isolate advanced CKD, and its Study Population section says the cohort could not be separated by diabetes type, although approximately 95% were estimated to have T2D. The finding supports an association, not a demonstrated causal risk factor; page numbers are unavailable in our copy. (LLM, conf=0.88)
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- Authors
- Pathak, R. D., Schroeder, E. B., Seaquist, E. R., Zeng, C., Lafata, J. E., Thomas, A., Desai, J., Waitzfelder, B., Nichols, G. A., Lawrence, J. M., Karter, A. J., Steiner, J. F., Segal, J., & O’Connor, P. J.
- Affiliations
- Marshfield Clinic (US)
- Kaiser Permanente (US)
- University of Minnesota (US)
- Henry Ford Health (US)
- HealthPartners (US)
- Kaiser Permanente Northern California (US)
- Johns Hopkins University (US)
- Corresponding author
- Pathak, Ram D.
- ORCID
- Venue
- Diabetes Care
- Publisher
- American Diabetes Association
- Published
- 2015-12-17
- Volume
- 39
- Issue
- 3
- Pages
- 363-370
- ISSN
- 0149-5992 (ISSN-L)
- 1935-5548
- PMC
- PMC4876672
- OpenAlex
- W2239573607
- Cited by
- 140
- References
- 50
- Citations by year
- 2026: 6 · 2025: 8 · 2024: 4 · 2023: 9 · 2022: 12 · 2021: 17 · 2020: 20 · 2019: 19 · 2018: 16 · 2017: 18 · 2016: 11
- FWCI
- 13.04
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Diabetes Care (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Agency for Healthcare Research and Quality (R01HS019859)
- 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
- severe hypoglycemia, diabetes mellitus, hypoglycemia incidence, risk factors, chronic kidney disease, congestive heart failure, cardiovascular disease, depression, glycemic control, insulin, insulin secretagogues, beta-blockers, HbA1c, integrated health system
- MeSH terms
- Adult, Aged, Blood Glucose, Diabetes Mellitus, Female, Humans, Hypoglycemia, Male, Middle Aged, United States, Cohort Studies, Comorbidity, Delivery of Health Care, Integrated, Disease Management, Young Adult
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
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