OBJECTIVE: To identify severe hypoglycemia events, defined as emergency department visits or hospitalizations for hypoglycemia, in patients with type 2 diabetes receiving care in a large health system and to identify patient characteristics associated with severe hypoglycemia events. RESEARCH DESIGN AND METHODS: This was a retrospective cohort study from January 2006 to December 2015 using the electronic medical record in the Cleveland Clinic Health System (CCHS). Participants included 50,439 patients with type 2 diabetes receiving care in the CCHS. Number of severe hypoglycemia events and associated patient characteristics were identified. RESULTS: The incidence proportion of severe hypoglycemia increased from 0.12% in 2006 to 0.31% in 2015 (P = 0.01). Compared with patients who did not experience severe hypoglycemia, those with severe hypoglycemia had similar median glycosylated hemoglobin (HbA1c) levels. More patients with severe hypoglycemia versus those without had a prior diagnosis of nonsevere hypoglycemia (9% vs. 2%, P < 0.001). Logistic regression confirmed an increased odds for severe hypoglycemia with insulin, sulfonylureas, increased number of diabetes medications, history of nonsevere hypoglycemia (odds ratio [OR] 3.01, P < 0.001), HbA1c <6% (42 mmol/mol) (OR 1.95, P < 0.001), black race, and increased Charlson comorbidity index. Lower odds of severe hypoglycemia were noted with higher BMI and use of metformin, dipeptidyl peptidase 4 inhibitors, and glucagon-like peptide 1 agonists. CONCLUSIONS: In this retrospective study of patients with type 2 diabetes with severe hypoglycemia, patient characteristics were identified. Patients with severe hypoglycemia had previous nonsevere hypoglycemia diagnoses more frequently than those without. Identifying patients at high risk at the point of care can allow for change in modifiable risk factors and prevention of severe hypoglycemia events.
OBJECTIVE: To identify severe hypoglycemia events, defined as emergency department visits or hospitalizations for hypoglycemia, in patients with type 2 diabetes receiving care in a large health system and to identify patient characteristics associated with severe hypoglycemia events. RESEARCH DESIGN AND METHODS: This was a retrospective cohort study from January 2006 to December 2015 using the electronic medical record in the Cleveland Clinic Health System (CCHS). Participants included 50,439 patients with type 2 diabetes receiving care in the CCHS. Number of severe hypoglycemia events and associated patient characteristics were identified. RESULTS: The incidence proportion of severe hypoglycemia increased from 0.12% in 2006 to 0.31% in 2015 (P = 0.01). Compared with patients who did not experience severe hypoglycemia, those with severe hypoglycemia had similar median glycosylated hemoglobin (HbA1c) levels. More patients with severe hypoglycemia versus those without had a prior diagnosis of nonsevere hypoglycemia (9% vs. 2%, P < 0.001). Logistic regression confirmed an increased odds for severe hypoglycemia with insulin, sulfonylureas, increased number of diabetes medications, history of nonsevere hypoglycemia (odds ratio [OR] 3.01, P < 0.001), HbA1c <6% (42 mmol/mol) (OR 1.95, P < 0.001), black race, and increased Charlson comorbidity index. Lower odds of severe hypoglycemia were noted with higher BMI and use of metformin, dipeptidyl peptidase 4 inhibitors, and glucagon-like peptide 1 agonists. CONCLUSIONS: In this retrospective study of patients with type 2 diabetes with severe hypoglycemia, patient characteristics were identified. Patients with severe hypoglycemia had previous nonsevere hypoglycemia diagnoses more frequently than those without. Identifying patients at high risk at the point of care can allow for change in modifiable risk factors and prevention of severe hypoglycemia events.
Authors: Scott J Pilla; Jenny Park; Jessica L Schwartz; Michael C Albert; Patti L Ephraim; L Ebony Boulware; Nestoras N Mathioudakis; Nisa M Maruthur; Mary Catherine Beach; Raquel C Greer Journal: J Gen Intern Med Date: 2021-01-21 Impact factor: 6.473
Authors: Lian A van Meijel; Femmie de Vegt; Evertine J Abbink; Femke Rutters; Miranda T Schram; Melanie M van der Klauw; Bruce H R Wolffenbuttel; Sarah Siegelaar; J Hans DeVries; Eric J G Sijbrands; Behiye Özcan; Harold W de Valk; Bianca Silvius; Nicolaas Schaper; Coen D A Stehouwer; Petra J M Elders; Cornelis J Tack; Bastiaan E de Galan Journal: BMJ Open Diabetes Res Care Date: 2020-02
Authors: Joseph Tibaldi; Martin Hadley-Brown; Andreas Liebl; Steffen Haldrup; Viktor Sandberg; Michael L Wolden; Helena W Rodbard Journal: Diabetes Obes Metab Date: 2019-01-08 Impact factor: 6.577
Authors: Anita D Misra-Hebert; Alex Milinovich; Alex Zajichek; Xinge Ji; Todd D Hobbs; Wayne Weng; Paul Petraro; Sheldon X Kong; Michelle Mocarski; Rahul Ganguly; Janine M Bauman; Kevin M Pantalone; Robert S Zimmerman; Michael W Kattan Journal: Diabetes Care Date: 2020-05-15 Impact factor: 19.112