Journal of diabetes investigation 2017 11 24() doi 10.1111/jdi.12778
To evaluate the incidence rate of and identify factors associated with severe hypoglycemic episodes in patients with treated T2DM.
Using Diagnosis Procedure Combination (DPC) hospital-based medical database, we performed a retrospective cohort study to assess the incidence rate of severe hypoglycemia in treated T2DM patients. We evaluated the associations between severe hypoglycemia and age, sex, complications and current use of insulin or sulfonylurea (SU) in a nested case control study.
Of 166,806 eligible patients, 1,242 had episodes of severe hypoglycemia during the observational period. The incidence rate of the first hypoglycemic events was 3.70/1,000 patient years. Based on the nested case-control analysis, age was associated with hypoglycemic events with adjusted odds ratios (ORs) of 1.64for 65-74 year-old patients and 3.79 for ≥75 year-old patients in comparison with 20-64 year-old patients. Comorbidities such as cognitive impairment, cancer, macrovascular disease and diabetic complications (retinopathy, nephropathy and neuropathy) were associated with severe hypoglycemia with adjusted ORs ranging from 1.25 to 3.80. Severe hypoglycemic events also increased in patients with current use of both SU and insulin, either SU or insulin, with adjusted ORs of 18.36, 6.31 or 14.07, respectively, compared with patients with other anti-hyperglycemic agents. In patients with an SU glimepiride, adjusted ORs increased dose-dependently from 3.65 (≤1mg) to 13.34 (>2mg).
The incidence rate of severe hypoglycemia in this cohort was 3.70/1,000 patient years. Age, cognitive impairment, cancer, diabetic complications, current use of insulin+SU, and SU dosage were identified as risk factors for severe hypoglycemia. This article is protected by copyright. All rights reserved.