Materiały źródłowe

• #1 Hypoglycemia – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK534841/

  Hypoglycemia is common with type 1 diabetes, particularly in those patients receiving intensive insulin therapy. Severe hypoglycemic events have reportedly been anywhere between 62 to 320 episodes per 100 patient-years in type 1 diabetes. […] As opposed to patients who have type 1 diabetes and require insulin therapy exclusively, patients with type 2 diabetes experience hypoglycemia relatively less frequently compared to patients with type 1 diabetes. This can be, in part, due to pharmacotherapies that do not induce hypoglycemia, like metformin. The incidence of hypoglycemia in patients with type 2 diabetes has been reportedly approximately 35 episodes for 100 patient years. […] There are no reported disparities in incidents based on gender.

• #2

  https://link.springer.com/article/10.1007/s11892-018-1018-0

  Hypoglycemia is the most common and often treatment-limiting serious adverse effect of diabetes therapy. […] We review the epidemiology of hypoglycemia in type 2 diabetes, discuss key risk factors, and introduce potential prevention strategies. […] Reported 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. […] 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.

• #3 Hypoglycemia – Wikipedia

  https://en.wikipedia.org/wiki/Hypoglycemia

  Hypoglycemia is common in people with type 1 diabetes, and in people with type 2 diabetes taking insulin, glinides, or sulfonylurea. It is estimated that type 1 diabetics experience two mild, symptomatic episodes of hypoglycemia per week. Additionally, people with type 1 diabetes have at least one severe hypoglycemic episode per year, requiring treatment assistance. In terms of mortality, hypoglycemia causes death in 6-10% of type 1 diabetics. […] In those with type 2 diabetes, hypoglycemia is less common compared to type 1 diabetics, because medications that treat type 2 diabetes like metformin, glitazones, alpha-glucosidase inhibitors, glucagon-like peptide 1 agonists, and dipeptidyl peptidase IV inhibitors, do not cause hypoglycemia. Hypoglycemia is common in type 2 diabetics who take insulin, glinides, or sulfonylurea. Insulin use remains a key risk factor in developing hypoglycemia, regardless of diabetes type.

• #4 Hypoglycaemia in diabetes mellitus: epidemiology and clinical implications | Nature Reviews Endocrinology

  https://www.nature.com/articles/nrendo.2014.170

  Hypoglycaemia, a common adverse effect of treatment of diabetes mellitus with insulin and sulphonylureas, is associated with impairment of cognitive function, which can have important consequences on everyday behaviour. […] Adults with type 1 diabetes mellitus have 2 episodes of mild hypoglycaemia per week; the annual prevalence of severe hypoglycaemia is 30%, with several factors, such as long disease duration, increasing its incidence. […] Adults with insulin-treated type 2 diabetes mellitus experience a lower frequency of mild and severe hypoglycaemia episodes than those with type 1 diabetes mellitus, but frequency rises progressively with increasing duration of insulin therapy. […] Prevention of hypoglycaemia is an important part of diabetes mellitus management and strategies include patient education, glucose monitoring, appropriate adjustment of diet and medications in relation to everyday circumstances including physical exercise, and the application of new technologies such as real-time continuous glucose monitoring, modified insulin pumps and the artificial pancreas.

• #5 SciELO Brazil – Epidemiology and risk factors of hypoglycemia in subjects with type 1 diabetes in Brazil: a cross-sectional, multicenter study Epidemiology and risk factors of hypoglycemia in subjects with type 1 diabetes in Brazil: a cross-sectional, mu

  https://www.scielo.br/j/aem/a/xvr6YvDN4CWjHQQTG6jvYBP/

  Of 1,760 individuals evaluated, 1,319 (74.9%) reported at least one episode of hypoglycemia in the previous 4 weeks. […] Severe hypoglycemia (SH), defined as an event requiring third-party assistance, occurs in approximately 30% of the individuals with T1D and is an important cause of morbidity. […] A Brazilian study evaluating the association between hypoglycemia severity and some chronic complications of diabetes in individuals with T1D has shown heart rate variability, chronic kidney disease, and macrovascular complications to be independent predictors of moderate hypoglycemia and SH. […] The percentage of SH episodes was evenly distributed across all ranges of HbA1c levels, and there were no correlations between the mean number of nonsevere or severe hypoglycemic events and HbA1c values.

• #6 Epidemiology and risk factors of hypoglycemia in subjects with type 1 diabetes in Brazil: a cross-sectional, multicenter study – Archives of Endocrinology and Metabolism

  https://www.aem-sbem.com/article/epidemiology-and-risk-factors-of-hypoglycemia-in-subjects-with-type-1-diabetes-in-brazil-a-cross-sectional-multicenter-study/

  Although individuals presenting with hypoglycemia had lower HbA1c values than those not presenting hypoglycemia, there were no correlations between the number of nonsevere hypoglycemia or SH and HbA1c values. Also, the frequency of SH was evenly distributed across all ranges of HbA1c values. Better adherence to SMBG and higher education level were associated with hypoglycemia, while alcohol consumption, higher doses of basal insulin, and more frequent hospitalizations in the previous year were associated with SH.

• #7 SciELO Brazil – Epidemiology and risk factors of hypoglycemia in subjects with type 1 diabetes in Brazil: a cross-sectional, multicenter study Epidemiology and risk factors of hypoglycemia in subjects with type 1 diabetes in Brazil: a cross-sectional, mu

  https://www.scielo.br/j/aem/a/xvr6YvDN4CWjHQQTG6jvYBP/

  Higher alcohol consumption and more frequent hospitalizations were independently associated with SH. […] Although individuals presenting with hypoglycemia had lower HbA1c values than those not presenting hypoglycemia, there were no correlations between the number of nonsevere hypoglycemia or SH and HbA1c values. […] Better adherence to SMBG and higher education level were associated with hypoglycemia, while alcohol consumption, higher doses of basal insulin, and more frequent hospitalizations in the previous year were associated with SH. […] In this large, population-based, observational study, NSH and SH in the previous 4 weeks occurred in, respectively, 74.9% and 19.0% of the subjects with T1D. […] Despite having lower HbA1c values, individuals in the HG had a higher frequency of retinopathy and lower eGFR values, which are probably related to a longer diabetes duration in this group and poor glycemic control in the first years after T1D diagnosis.

• #8 Hypoglycemia: Practice Essentials, Background, Pathophysiology

  https://emedicine.medscape.com/article/122122-overview

  The incidence of hypoglycemia in a population is difficult to ascertain. Patients and physicians frequently attribute symptoms (eg, anxiety, irritability, hunger) to hypoglycemia without documenting the presence of low blood sugar. The true prevalence of hypoglycemia, with blood sugar levels below 50 mg/dL, is generally 5-10% of people presenting with symptoms suggestive of hypoglycemia. […] A Brazilian study, by Lamounier et al, found that during a 4-week prospective evaluation period, at least one hypoglycemic event occurred in 91.7% of study patients with type 1 diabetes and in 61.8% of those with type 2 diabetes. This included nocturnal hypoglycemia in 54.0% and 27.4% of patients, respectively; asymptomatic hypoglycemia in 20.6% and 10.6% of patients, respectively; and severe hypoglycemic events in 20.0% and 10.3% of patients, respectively.

• #9 Hypoglycemia epidemiology and demographics – wikidoc

  https://www.wikidoc.org/index.php/Hypoglycemia_epidemiology_and_demographics

  Event rate for severe hypoglycemia ranges from 40 to 100 percent of patients with type 1 diabetes. […] Frequency of hypoglycemia in patients with type 2 diabetes is the same as type 1 diabetes, as insulin deficiency occurs at the end in DM type 2 and require aggressive treatment with insulin. […] Hypoglycemia is uncommon in individuals who do not have drug-treated diabetes mellitus. […] Hypoglycemia commonly affects patients with type 2 diabetes. So, the risk of severe hypoglycemia is low in the first few years (7%) and that risk increases to 25% later in the course of diabetes according to the UK Hypoglycemia Study. […] There is no gender predilection of hypoglycemia. […] There is no racial predilection of hypoglycemia.

• #9 Hypoglycemia epidemiology and demographics – wikidoc

  https://www.wikidoc.org/index.php/Hypoglycemia_epidemiology_and_demographics

  Patients with type 1 diabetes may suffer an average of two episodes of symptomatic hypoglycemia per week, thousands of such episodes over a lifetime of diabetes, and one episode of severe symptoms per year. […] Hypoglycemia is less frequent in type 2 diabetes than it is in type1. […] Worldwide, the incidence of severe hypoglycemia event was 4800 per 100.000 patient per year and of moderate events was 13100 per 100.000 patient per year. […] Rates of hypoglycemia were increased in children 6 years of age. […] Patients with type 1 diabetes may have increased frequency of symptomatic hypoglycemia which may include one severe episode per year. […] Hypoglycemia is less frequent in type 2 diabetes than it is in type1. […] Event rate for severe hypoglycemia in insulin-treated type 2 diabetes is approximately 30% of that in type 1.

• #10 Hypoglycemia Unawareness—A Review on Pathophysiology and Clinical Implications

  https://www.mdpi.com/2227-9059/12/2/391

  Hypoglycemia is a particular problem in people with diabetes while it can also occur in other clinical circumstances. […] The risk factors include intensive glycemic control, prior episodes of severe hypoglycemia, long duration of diabetes, alcohol consumption, exercise, renal failure, and sepsis. […] Hypoglycemia unawareness poses significant safety risks to patients. Individuals experiencing hypoglycemia unawareness are more likely to undergo severe hypoglycemic episodes, leading to accidents, injuries, and increased healthcare utilization. […] In conclusion, hypoglycemia unawareness is a significant complication in diabetes treatment that poses serious risks to individuals. Failure to identify hypoglycemia in a timely manner can lead to severe consequences, including unconsciousness, seizures, and even death. Various risk factors contribute to the development of hypoglycemia unawareness, such as intensive glycemic control, prior episodes of severe hypoglycemia, longer duration of diabetes, alcohol consumption, exercise, renal failure, and sepsis.

• #11 A general view of epidemiology of hypoglycemia in type 1 and type 2 diabetes mellitus | Charles Explorer

  https://nomos.is.cuni.cz/publication/562744?query=minimalizace+rizika&lang=en

  A general view of epidemiology of hypoglycemia in type 1 and type 2 diabetes mellitus […] Hypoglycemia particularly severe one is important side effect of diabetes therapy with impact on patient’s quality of life and mortality. The highest risk of hypoglycemia is connected with insulin therapy followed by derivates of sulfonylurea (SU) and glinides. […] The risk of hypoglycemia found in observational studies were 2-3 times higher in patients treated with SU and 3-4 higher when treated with insulin compared with other types of antidiabetics. The risk of hypoglycemia is increased in patients over 75 years of age, with longer period of treatment with insulin and in those treated with several types of antidiabetics.

• #12 Epidemiology and outcomes of hypoglycemia in patients with advanced diabetic kidney disease on dialysis: A national cohort study | PLOS One

  https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0174601

  This study found hypoglycemic episodes in DKD to be associated with subsequent hypoglycemia within 1-year following the initiation of dialysis. Previous hypoglycemia is a risk factor associated with further hypoglycemia. Therefore, patients with more comorbidities are at risk for recurrent hypoglycemia and should be closely monitored. […] In conclusion, the rate of severe hypoglycemia was high in advanced DKD patients. Severe hypoglycemic episodes and diabetic complications associated with subsequent hypoglycemia and mortality in these patients once on dialysis. We studied the associations and further study is needed to establish cause. In addition, more attention is needed in the monitoring of glucose and the use of anti-diabetic medications in DKD patients, especially for those at risk patients.

• #13 Epidemiology of hypoglycemia among ambulatory – ProQuest

  https://www.proquest.com/scholarly-journals/epidemiology-hypoglycemia-among-ambulatory-type-2/docview/2089044574/se-2

  Aim: The study was aimed at describing the epidemiology of hypoglycemia among ambulatory type 2 diabetic patients in a primary care clinic in Eastern Nigeria. […] The prevalence of hypoglycemia was 35.2%. […] Hypoglycemia occurred predominantly among the elderly (72.5%), male gender (54.9%), outside home environment (72.5%), during the daytime (82.4%), duration of diabetes 1 year (58.8%), and patients on insulin secretagogues alone (46.2%). […] Experience of hypoglycemia was significantly associated with elderly age (P = 0.025), duration of diabetes 1 year (P = 0.021), and use of insulin secretagogues alone (P = 0.043). […] The most significant predictor of hypoglycemic events was use of insulin and insulin secretagogues (odds ratio = 3.15 [1.745.66]; P = 0.002). […] Type 2 diabetic patients on insulin and insulin secretagogues were three times more likely to experience hypoglycemic events compared to their counterparts who were on insulin sensitizers.

• #14 Incidence and predictors of hypoglycemia in Japanese patients with type 2 diabetes treated by insulin glargine and oral antidiabetic drugs in real-life: ALOHA post-marketing surveillance study sub-analysis | Diabetology & Metabolic Syndrome | Full Tex

  https://dmsjournal.biomedcentral.com/articles/10.1186/1758-5996-6-20

  Among 4219 patients, 44 (1.0%) patients experienced hypoglycemic episodes (41 insulin-nave patients; 3 insulin non-nave patients), with a rate of incidence 0.035 episodes/patient-years. […] Our results suggest that BOT using insulin glargine is an option of insulin therapy with 1% risk of hypoglycemia in patients with T2DM with inadequate glycemic control. […] The overall incidence of hypoglycemia was 1.0%, with majority of patients experienced hypoglycemia only once during 24-week follow-up period. […] The study also demonstrated, for the first time, that among insulin-nave T2DM Japanese patients, hypoglycemia is associated with poor renal function. […] Among the diabetic complications, the NNH was low for retinopathy and/or nephropathy. […] Multivariate adjusted negative binomial regression model revealed that among the parameters studied, poor renal function defined as eGFR 60 mL/min/1.73 m2 was the only statistically significant risk factor of hypoglycemic events (relative risk [RR] 5.34, 95% confidence interval [CI] 1.48-22.85, P 0.05). […] Age, presence of diabetic complications, and poor renal function were the predictors of hypoglycemia in insulin-nave patients.

• #15 SciELO Brazil – Epidemiology and risk factors of hypoglycemia in subjects with type 1 diabetes in Brazil: a cross-sectional, multicenter study Epidemiology and risk factors of hypoglycemia in subjects with type 1 diabetes in Brazil: a cross-sectional, mu

  https://www.scielo.br/j/aem/a/xvr6YvDN4CWjHQQTG6jvYBP/

  The higher frequency of CSII use in the HG was probably due to reverse causality, since an excessive number of hypoglycemic events is among the indications for this therapeutic modality. […] Previous data have implicated alcohol in up to one-fifth of hospital admissions due to hypoglycemia in individuals treated with insulin.

• #16

  https://link.springer.com/article/10.1007/s11892-018-1018-0

  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. […] Hypoglycemia 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. […] This study demonstrated that only 5% of severe hypoglycemic events experienced by patients with diabetes culminate in an emergency department visit or hospitalization event.

• #17 Epidemiology and outcomes of hypoglycemia in patients with advanced diabetic kidney disease on dialysis: A national cohort study | PLOS One

  https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0174601

  Epidemiology and outcomes of hypoglycemia in patients with advanced diabetic kidney disease on dialysis: A national cohort study […] Patients with advanced diabetic kidney disease (DKD) behave differently to diabetic patients without kidney disease. We aimed to investigate the associations of hypoglycemia and outcomes after initiation of dialysis in patients with advanced DKD on dialysis. […] 19.18% patients had at least one hypoglycemia episode during 1-year period before initiation of dialysis. Advanced DKD patients with higher adapted Diabetes Complications Severity Index (aDCSI) scores were associated with more frequent hypoglycemia (P for trend 0.001). Mortality and subsequent severe hypoglycemia after dialysis both increased with number of hypoglycemic episodes. Compared to those who had no hypoglycemic episodes, those who had one had a 15% higher risk of death and a 2.3-fold higher risk of subsequent severe hypoglycemia. Those with two or more episodes had a 19% higher risk of death and a 3.9-fold higher risk of subsequent severe hypoglycemia.

• #18 Epidemiology and outcomes of hypoglycemia in patients with advanced diabetic kidney disease on dialysis: A national cohort study

  https://ideas.repec.org/a/plo/pone00/0174601.html

  Background: Patients with advanced diabetic kidney disease (DKD) behave differently to diabetic patients without kidney disease. We aimed to investigate the associations of hypoglycemia and outcomes after initiation of dialysis in patients with advanced DKD on dialysis. […] We investigated the incidence of severe hypoglycemia episodes before initiation of dialysis. Patients were followed from date of first dialysis to death, end of dialysis, or 2008. Main outcomes measured were all-cause mortality, myocardial infarction (MI), and subsequent severe hypoglycemic episodes after dialysis. […] 19.18% patients had at least one hypoglycemia episode during 1-year period before initiation of dialysis. Advanced DKD patients with higher adapted Diabetes Complications Severity Index (aDCSI) scores were associated with more frequent hypoglycemia.

• #19

  https://journals.lww.com/jhrr/fulltext/2018/05020/epidemiology_of_hypoglycemia_among_ambulatory_type.1.aspx

  The study was aimed at describing the epidemiology of hypoglycemia among ambulatory type 2 diabetic patients in a primary care clinic in Eastern Nigeria. […] The prevalence of hypoglycemia was 35.2%. Hypoglycemia occurred predominantly among the elderly (72.5%), male gender (54.9%), outside home environment (72.5%), during the daytime (82.4%), duration of diabetes 1 year (58.8%), and patients on insulin secretagogues alone (46.2%). […] The study has shown variable epidemiology of hypoglycemia. The incident occurred predominantly among the elderly, male gender, during daytime, outside home environment, duration of diabetes 1 year, and patients on insulin and insulin secretagogues. […] Effective reduction of hypoglycemic crisis syndrome in diabetic Nigerians depends largely on the adequate understanding of its epidemiology.

• #20 SciELO Brazil – Epidemiology and risk factors of hypoglycemia in subjects with type 1 diabetes in Brazil: a cross-sectional, multicenter study Epidemiology and risk factors of hypoglycemia in subjects with type 1 diabetes in Brazil: a cross-sectional, mu

  https://www.scielo.br/j/aem/a/xvr6YvDN4CWjHQQTG6jvYBP/abstract/?lang=en

  Of 1,760 individuals evaluated, 1,319 (74.9%) reported at least one episode of hypoglycemia in the previous 4 weeks. […] The main factors associated with hypoglycemia were lower hemoglobin A1c (HbA1c) level, better adherence to self-monitoring of blood glucose (SMBG), and higher education level. […] Episodes of SH were reported by 251 (19%) individuals who, compared with subjects with nonsevere hypoglycemia, received lower doses of prandial insulin and higher doses of basal insulin, in addition to reporting less frequent use of long-acting basal insulin analogs. […] Higher alcohol consumption and more frequent hospitalizations were independently associated with SH. […] Although individuals presenting with hypoglycemia had lower HbA1c values than those not presenting hypoglycemia, there were no correlations between the number of nonsevere hypoglycemia or SH and HbA1c values. […] Better adherence to SMBG and higher education level were associated with hypoglycemia, while alcohol consumption, higher doses of basal insulin, and more frequent hospitalizations in the previous year were associated with SH.

• #21 Severe Hypoglycemia Linked to Increased Risk of Death in People With Diabetes | Johns Hopkins | Bloomberg School of Public Health

  https://publichealth.jhu.edu/2017/severe-hypoglycemia-linked-to-increased-risk-of-death-in-people-with-diabetes

  A single instance of blood sugar falling so low as to require an emergency department visit was associated with nearly double the risk of cardiovascular disease or death, finds a new Johns Hopkins Bloomberg School of Public Health study of older adults with type 2 diabetes. […] Additionally, using data from a large longitudinal study, the researchers found that one third of the older adults with diabetes who had experienced a severe low blood sugar episode (hypoglycemia) died within three years of the incident. […] The researchers say that their findings suggest that doctors might want to pay special attention to patients who have been sent to the emergency department for hypoglycemia after losing consciousness, having a seizure or experiencing another serious health event. […] Hypoglycemia is clearly an under-recognized risk factor for death and cardiovascular disease in people with diabetes.

• #22

  https://www.healio.com/news/primary-care/20180416/small-proportion-of-hypoglycemia-events-captured-by-surveillance

  Pharmacologically treated patients with diabetes commonly reported experiencing severe hypoglycemic events; however, health care utilization-based surveillance captured only about 5% of self-reported events, according to findings published in JAMA Internal Medicine. […] Data indicated that 11.7% of participants experienced one or more severe hypoglycemia events that required third party assistance within the past year. A hypoglycemic event resulting in ED or hospital utilization occurred in only 0.8% of participants. Additionally, 5.2% of participants who reported having severe hypoglycemia were admitted to the ED or hospital. […] These findings suggest that current surveillance grossly underestimates the overall burden of severe hypoglycemia, according to Karter and colleagues. […] Because most severe hypoglycemic events occur outside of the health care system, a more complete understanding of the burden of severe hypoglycemia will require collecting self-reported events, they wrote. […] Determining the total burden of severe hypoglycemia, not just the small subset of events leading to health care utilization, will better inform clinical decision making, public health policy, and quality measure development to enhance patient safety, they concluded.

• #23 High prevalence of impaired awareness of hypoglycemia and severe hypoglycemia among people with insulin-treated type 2 diabetes: The Dutch Diabetes Pearl Cohort | BMJ Open Diabetes Research & Care

  https://drc.bmj.com/content/8/1/e000935

  People with type 2 diabetes on insulin are at risk for hypoglycemia. […] The aim of this study was to assess the prevalence and determinants of self-reported IAH and severe hypoglycemia in a Dutch nationwide cohort of people with insulin-treated type 2 diabetes. […] A total of 229 patients (9.7%) were classified as having IAH and 742 patients (31.6%) reported severe hypoglycemia. […] In this nationwide cohort, almost one out of ten people with type 2 diabetes on insulin had IAH and 30% had a history of severe hypoglycemia in the past year. […] The reported prevalence of hypoglycemic events in people with type 2 diabetes on insulin therapy is highly variable and partly determined by the duration and intensity of insulin therapy. […] The aim of this study was to assess the prevalence and determinants of IAH and severe hypoglycemia in a large nationwide cohort of patients with insulin-treated type 2 diabetes.

• #24 High prevalence of impaired awareness of hypoglycemia and severe hypoglycemia among people with insulin-treated type 2 diabetes: The Dutch Diabetes Pearl Cohort | BMJ Open Diabetes Research & Care

  https://drc.bmj.com/content/8/1/e000935

  The primary outcome of this study was the prevalence of IAH in people with type 2 diabetes on insulin therapy. […] In this nationwide cohort of patients with type 2 diabetes treated with insulin, we found that the prevalence of IAH was 9.7% and that almost one out of three individuals reportedly experienced a severe hypoglycemic event in the preceding year. […] Our data on the prevalence of IAH in people with insulin-treated type 2 diabetes are in line with those reported in small studies using either the Gold score or the Clarke questionnaire, and extend these to a more general population of people with type 2 diabetes on insulin, including those from primary care. […] Our study has clinical implications as it shows that both IAH and severe hypoglycemia are common in people with type 2 diabetes on insulin therapy, even in those using basal insulin therapy alone or managed in primary care. […] Greater awareness for IAH and severe hypoglycemia in people with type 2 diabetes on insulin is needed, with special attention for people without a partner or with non-Caucasian ethnicities.

• #25 Severe Hypoglycemia Linked to Increased Risk of Death in People With Diabetes | Johns Hopkins | Bloomberg School of Public Health

  https://publichealth.jhu.edu/2017/severe-hypoglycemia-linked-to-increased-risk-of-death-in-people-with-diabetes

  One to two per 100 people with diabetes per year experience severe hypoglycemia ending in a hospital visit, Lee says. […] They found that 192 experienced hypoglycemia that led to an emergency room visit or hospitalization. Those people were nearly twice as likely to die of any cause than those people with diabetes who did not have severe hypoglycemia. […] Researchers say that past studies have shown that people who experience severe hypoglycemia experience low-level heart damage, so a biological link between hypoglycemia and death from cardiovascular disease could be an extension of that. […] If diabetes medications are used improperly, blood sugar can get dangerously low.

• #26 Hypoglycaemia (Causes, Symptoms, and Treatment)

  https://patient.info/doctor/hypoglycaemia

  Hypoglycaemia is uncommon in people without diabetes. […] Studies have also suggested that hypoglycaemia is associated with an increased risk of cardiovascular events and mortality. […] Severe hypoglycaemia is estimated to be associated with an increased future mortality risk of 50-60%.

• #27 Participatory surveillance of hypoglycemia and harms in an online social network.

  https://research.childrenshospital.org/elissarweitzman/publications/participatory-surveillance-hypoglycemia-and-harms-online-social-network

  Participatory surveillance of hypoglycemia and harms in an online social network. […] Surveillance systems for elucidating the burden of hypoglycemia are limited. […] To quantify experiences of hypoglycemia and related harms, members of an international online diabetes social network with insulin-dependent diabetes mellitus were polled through a software application („app”). […] Of 613 respondents (24.3% of app users), 49.1% reported more than 4 episodes of „going low” in the past 2 weeks and 29.2% reported 1 or more severe low in the past year; 16.6% reported both more than 4 recent low episodes and 1 or more severe event in the past year. […] Harms were common, including daily debilitating worry (45.8%), vehicle crash or injury (15.0%), and withdrawal from exercise, driving, leaving home, and having sex (54.0%, 37.4%, 24.8%, and 22.7%, respectively). […] Participatory surveillance of hypoglycemia in an online diabetes social network enables characterization of patient-centered harms in a community sample and bidirectional communication with affected persons, augmenting traditional surveillance.

• #28 National Estimates of Insulin-related Hypoglycemia and Errors Leading to Emergency Department Visits and Hospitalizations

  https://stacks.cdc.gov/view/cdc/36390

  Importance Detailed, nationally-representative data describing high-risk populations and circumstances involved in insulin-related hypoglycemia and errors (IHEs) can inform approaches to individualizing glycemic targets. […] Objective Describe U.S. burden, rates, and characteristics of emergency department (ED) visits and emergent hospitalizations for IHEs. […] Based on 8,100 cases, an estimated 97,648 (95% confidence interval [CI], 64,410130,887) ED visits for IHEs occurred annually; almost one-third (29.3% [CI, 21.8%36.8%]) resulted in hospitalization. […] Insulin-treated patients aged 80 years were more than twice as likely to visit the ED (rate ratio, 2.5; CI, 1.54.3) and nearly five times as likely to be subsequently hospitalized (rate ratio, 4.9; CI, 2.69.1) for IHEs than those aged 4564 years. […] Rates of ED visits and subsequent hospitalizations for IHEs were highest in patients aged 80 years; the risks of hypoglycemic sequelae in this age group should be considered in decisions to prescribe and intensify insulin.

• #29 Prevalence and predictors of hypoglycemia in older outpatients with type 2 diabetes mellitus | PLOS One

  https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0309618

  The prevalence of type 2 diabetes (DM) has been increasing globally, particularly among older adults who are more susceptible to DM-related complications. Elderly individuals with diabetes are at higher risk of developing hypoglycemia compared with younger diabetes patients. Hypoglycemia in elderly patients can result in serious consequences such as cognitive changes, increased risk of falls, heart and other vascular problems, and even high mortality rate. […] To assess prevalence, and factors associated with hypoglycemia events among geriatric outpatients with type 2 diabetes mellitus. […] Hypoglycemia was prevalent in 21.7% of the patients. […] Patients with liver diseases had a significantly higher risk of hypoglycemia, with odds 7.43 times higher than patients without liver diseases.

• #30 Prevalence and predictors of hypoglycemia in older outpatients with type 2 diabetes mellitus | PLOS One

  https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0309618

  Current study identified a considerable prevalence of hypoglycemia among older patients with type 2 diabetes, particularly, among those with concurrent liver diseases and dyslipidemia. Furthermore, hypoglycemia was associated with an increased rate of emergency department visits and hospital admissions by 2 folds in this population. […] Results of the current study estimated that prevalence of hypoglycemia among elderly patients was 21.7%. […] Our study indicated that 14.4% of the study patients reported severe hypoglycemia, while 42.4 and 43.2% of the patients reported moderate and mild hypoglycemia, respectively. […] The presence of chronic comorbidities including liver conditions and dyslipidemia were linked to an increase in the risk of hypoglycemic events in this study. […] Patients who had developed hypoglycemia were more subjected to emergency department visits and hospital admissions.

• #31 Epidemiology and outcomes of hypoglycemia in patients with advanced diabetic kidney disease on dialysis: A national cohort study | PLOS One

  https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0174601

  Patients with advanced DKD have a higher risk of hypoglycemia. The current study also found DKD patients with higher aDCSI scores tended to have more frequent episodes of hypoglycemia. Hypoglycemia may indicate an underlining health problem. The incidence of hypoglycemia is higher in patients with DKD than those without DKD, probably due to the reduction in insulin requirement associated with renal insufficiency. […] This study found hypoglycemia to be associated with higher mortality risk in patients with advanced DKD. Hypoglycemia has been reported to be related to increases in one-day mortality in patients with DKD. The ADVANCE study reported severe hypoglycemia to be associated with an increase in death risk. Furthermore, we found an association between frequency of hypoglycemic episodes and increased long-term mortality in ESRD dialysis patients.

• #32 Neonatal Hypoglycemia: Practice Essentials, Background, Pathophysiology

  https://emedicine.medscape.com/article/802334-overview

  The overall incidence of symptomatic hypoglycemia in newborns varies from 1.3-3 per 1000 live births. Incidence varies with the definition, population, method and timing of feeding, and the type of glucose assay. Serum glucose levels are higher than whole blood values. The incidence of hypoglycemia is greater in high-risk neonatal groups (see History). […] Early feeding decreases the incidence of hypoglycemia. Inborn errors of metabolism that lead to neonatal hypoglycemia are rare but can be screened for in infancy. […] In a Japanese study, more than 80% of admissions from the nursery to the neonatal intensive care unit (NICU) after birth were due to apnea or hypoglycemia in neonates born at 35-36 weeks’ gestation.

• #33 Post-Bariatric Hypoglycemia – Epidemiology Forecast – 2032

  https://www.researchandmarkets.com/reports/5525540/post-bariatric-hypoglycemia-epidemiology?srsltid=AfmBOoo98YOMHXsFInsVdFkLWzvH80tbvujzNHAvO1u1CqelshiW2i1E

  This „Post-Bariatric Hypoglycemia – Epidemiology Forecast to 2032” report delivers an in-depth understanding of the disease, historical and forecasted Post-Bariatric Hypoglycemia epidemiology in the 7MM, i.e., the United States, EU5 (Germany, Spain, Italy, France, and the United Kingdom), and Japan. […] The Post-Bariatric Hypoglycemia epidemiology report gives a thorough understanding of the Post-Bariatric Hypoglycemia by including details such as disease definition, symptoms, causes, pathophysiology, and diagnosis. […] The Post-Bariatric Hypoglycemia epidemiology division provides insights about historical and current patient pool and forecasted trend for every seven major countries. […] The Post-Bariatric Hypoglycemia epidemiology segment covers the epidemiology data in the US, EU5 countries (Germany, Spain, Italy, France, and the UK), and Japan from 2019 to 2032.

• #34 Post-Bariatric Hypoglycemia – Epidemiology Forecast – 2032

  https://www.researchandmarkets.com/reports/5525540/post-bariatric-hypoglycemia-epidemiology?srsltid=AfmBOoo98YOMHXsFInsVdFkLWzvH80tbvujzNHAvO1u1CqelshiW2i1E

  The Post-Bariatric Hypoglycemia report also provides the epidemiology trends observed in the 7MM during the study period, along with the assumptions undertaken. […] The report provides insight into the historical and forecasted patient pool of Post-Bariatric Hypoglycemia in seven major markets covering the United States, EU5 (Germany, Spain, France, Italy, UK), and Japan. […] The report assesses the disease risk and burden and highlights the unmet needs of Post-Bariatric Hypoglycemia. […] The calculated data are presented with relevant tables and graphs to give a clear view of the epidemiology at first sight. […] The Post-Bariatric Hypoglycemia Epidemiology Model developed by the publisher is easy to navigate, interactive with dashboards, and epidemiology based with transparent and consistent methodologies.

• #35 Hypoglycemia – Epidemiology Forecast to 2030 – Market Research Reports & Consulting | GlobalData UK Ltd.

  https://www.globaldata.com/store/report/hypoglycemia-epidemiology-analysis/

  GlobalData epidemiologists forecast that the diagnosed incident cases of hypoglycemia attributed to T1D and T2D in the 7MM will grow by an annual growth rate (AGR) of 0.21% over the next 10 years, from 1,483,850 cases in 2020 to 1,515,114 cases in 2030. Diagnosed incident cases of non-diabetic hypoglycemia will increase from 479,409 cases in 2020 to 489,344 cases in 2030 in the 7MM, at an AGR of 0.21%. These trends mirror changes in the underlying, at-risk populations, such as the rising incidence of T2D, the most common type of diabetes. While hypoglycemia has long been recognized as an inevitable consequence of diabetes therapy, it is being increasingly viewed as a potentially preventable cause of impaired quality of life and mortality. […] The Hypoglycemia Epidemiology Report and Model provide an overview of the risk factors, comorbidities, and global trends of Hypoglycemia in the seven major markets (7MM: US, France, Germany, Italy, Spain, UK, and Japan).

• #36 Real-world crude incidence of hypoglycemia in adults with diabetes: Results of the InHypo-DM Study, Canada | BMJ Open Diabetes Research & Care

  https://drc.bmj.com/content/6/1/e000503

  A total of 552 people (T2DM: 83%; T1DM: 17%) completed the questionnaire. […] Over half (65.2%) of the total respondents reported experiencing at least one event (non-severe or severe) at an annualized crude incidence density of 35.1 events per person-year. […] The results of the InHypo-DMPQ, the largest real-world investigation of hypoglycemia epidemiology in Canada, suggest that the incidence of hypoglycemia among adults with diabetes taking insulin and/or insulin secretagogues is higher than previously thought. […] The population-based frequency of hypoglycemia was high across all respondents, with close to two-thirds of the respondents reporting at least one non-severe (in the last 30 days) or severe (in the last year) hypoglycemia event. […] Rates of severe hypoglycemia were also markedly high, particularly among respondents who had also reported at least one non-severe event.

• #37 Real-world crude incidence of hypoglycemia in adults with diabetes: Results of the InHypo-DM Study, Canada | BMJ Open Diabetes Research & Care

  https://drc.bmj.com/content/6/1/e000503

  The present results generally exceed the frequency estimates derived from traditional glucose-lowering clinical trials. […] The InHypo-DM study presents a comprehensive, population-based examination of hypoglycemia, including daytime, nocturnal, non-severe, and severe hypoglycemia, that allows for comparison of both incidence proportion and incidence rate. […] The results of the InHypo-DMPQ, the largest real-world investigation of hypoglycemia epidemiology in Canada, suggest that the incidence of hypoglycemia among adults with diabetes taking insulin and/or secretagogues is higher than previously thoughtespecially among respondents with T2DM.

• #38 Epidemiology and outcomes from severe hypoglycemia in Kuwait: a prospective cohort study | BMC Emergency Medicine | Full Text

  https://bmcemergmed.biomedcentral.com/articles/10.1186/s12873-021-00457-9

  The objective of this study was to describe the epidemiology of severe hypoglycaemia in Kuwait, aiming to provide a preliminary background to update the current guidelines and improve patient management. […] A total of 167 cases met the inclusion criteria. The incidence of severe hypoglycaemia in the national EMS was 11 per 100,000. […] Severe hypoglycaemia is not uncommon during EMS calls. Appropriate management by EMS personnel is fruitful, resulting in favourable scene outcomes and reducing the hospital transportation rate. […] The study describes severe hypoglycaemia epidemiology in Kuwait, which has not been described before. Our results showed that severe hypoglycaemia resulting in a request for EMS is common in Kuwait EMS emergencies. Eleven per 100,000 EMS calls were for severe hypoglycaemia.

• #39 Epidemiology and outcomes from severe hypoglycemia in Kuwait: a prospective cohort study | BMC Emergency Medicine | Full Text

  https://bmcemergmed.biomedcentral.com/articles/10.1186/s12873-021-00457-9

  Collectively, this cohort is the first in the current literature to report overall favourable on-scene outcomes with severe hypoglycaemia: normal GCS after 1030min on scene and normal RBS on scene after 1030min. It also contributes to identifying the role of parenteral glucose in reducing hospital transportation rates.

• #40 Hypoglycemia Prevention Initiative | Endocrine Society

  https://www.endocrine.org/hypoglycemia-prevention-initiative

  The Hypoglycemia Prevention Initiative is a multi-year joint effort of the Endocrine Society and Avalere Health to determine best practices in primary care to reduce the impact of hypoglycemia on older (65+) people with type 2 diabetes (T2D) who use insulin and/or sulfonylurea, have a recent A1c 7%, and are at increased risk of hypoglycemia. […] The study, Reducing Hypoglycemia From Overtreatment of Type 2 Diabetes in Older Adults: The HypoPrevent Study, was published September 21, 2023, in the Journal of the American Geriatrics Society. […] Objectives: 1: Increasing outpatient hypoglycemia surveillance risk assessment by integrating a risk assessment into primary care clinical workflow. […] 2: Improving the management of older type 2 diabetes patients on insulin and sulfonylureas. […] 3: Developing outpatient hypoglycemia quality measures and integrating them into primary care practices to incentivize high-quality care.

• #41 Severe Hypoglycemia: Ascertainment, Surveillance and Pharmacovigalence – Kaiser Permanente Division of Research

  https://divisionofresearch.kaiserpermanente.org/studies/severe-hypoglycemia-ascertainment-surveillance-and-pharmacovigalence/

  Severe hypoglycemia (SH), defined as low blood sugar for which the patient requires assistance, has emerged as one of the most prevalent complications of diabetes treatment and a critical public health concern. […] It has been estimated that among older adults, one in four emergency hospitalizations for adverse drug events are due to SH. […] We will study SH in a large population of adults with type 2 diabetes, develop improved tools to identify SH and obtain a better understanding of risks associated with each diabetes drug, as well as their interactions with non-diabetic drugs.

• #42

  https://grantome.com/grant/NIH/R01-DK103721-04

  Most patients with type 2 diabetes are prescribed medications to lower glucose levels and reduce the risk of long-term complications. Severe hypoglycemia (SH) occurs as an unintended consequence of medications (i.e., an iatrogenic effect) and is defined as a low blood glucose level for which the patient requires assistance. […] Despite advances in pharmacotherapy, SH leading to emergency department (ED) visits or hospitalization has emerged as one of the most prevalent complications of diabetes treatment and is a critical public health concern. One in four emergency hospitalizations for adverse drug events among older adults is due to SH. […] This study will 1) provide new SH ascertainment tools to improve surveillance nationwide and thereby enable a more comprehensive understanding of SH epidemiology; and 2) provide valid estimates of change in SH risk associated with initiation of medications commonly used by people with diabetes, thus helping providers and patients individualize diabetes management while minimizing the risk of SH.

• #43

  https://grantome.com/grant/NIH/R01-DK103721-04

  Severe hypoglycemia (SH), defined as low blood sugar for which the patient requires assistance, has emerged as one of the most prevalent complications of diabetes treatment and a critical public health concern. SH is associated with poor quality of life, serious falls, car accidents, arrhythmia, dementia, hospitalizations, and a greatly increased risk of death. It has been estimated that among older adults, one in four emergency hospitalizations for adverse drug events are due to SH. We will study SH in a large population of adults with type 2 diabetes, develop improved tools to identify SH and obtain a better understanding of risks associated with each diabetes drug, as well as their interactions with non-diabetic drugs.

• #44

  https://link.springer.com/article/10.1007/s11892-018-1018-0

  This study analyzed 594,146 hospitalizations among commercially insured and Medicare Advantage beneficiaries with diabetes between 2009 and 2014 and found that 1.3% of all hospitalizations were for the primary diagnosis of hypoglycemia. […] In this nationwide U.S. study conducted among commercially insured adults in the USA, Basu and colleagues demonstrated the association between household income and risk of hypoglycemia-related emergency department visits and hospitalizations, thereby highlighting the potential impact of food insecurity even among insured adults. […] High rates of severe hypoglycemia among African American patients with diabetes: the surveillance, prevention, and Management of Diabetes Mellitus (SUPREME-DM) network.

• #45 Hypoglycemia Prevention Initiative | Endocrine Society

  https://www.endocrine.org/hypoglycemia-prevention-initiative

  Average incidence of hypoglycemia among people with T2D on insulin is 23 mild or moderate events and 1 severe episode per year. […] Among Medicare-aged individuals, hospitalization for hypoglycemia is associated with a 30-day readmission rate of 18.1%. […] Primary care clinicians provide the majority of care for people with T2D.

• #46 The screening and management of newborns at risk for low blood glucose | Canadian Paediatric Society

  https://cps.ca/documents/position/newborns-at-risk-for-low-blood-glucose

  Hypoglycemia in the first hours to days after birth remains one of the most common conditions facing practitioners across Canada who care for newborns. […] Screening, monitoring, and intervention protocols have been revised to better identify, manage, and treat infants who are at risk for persistent, recurrent, or severe hypoglycemia. […] This statement differentiates between approaches to care for hypoglycemia during the transitional phase—the first 72 hours post-birth—and persistent hypoglycemia, which occurs or presents for the first time past that point. […] Hypoglycemia in the first hours to days after birth remains one of the most common conditions facing practitioners across Canada who care for newborns, and despite the passage of many years since the last statement was published, essential questions about neonatal hypoglycemia remain largely the same.

• #47 The screening and management of newborns at risk for low blood glucose | Canadian Paediatric Society

  https://cps.ca/documents/position/newborns-at-risk-for-low-blood-glucose

  Current evidence suggests that the therapeutic goal for glucose levels in infants with persistent hypoglycemia should be 3.3 mmol/L after 72 hours post-birth. […] Recommendations for the management of hypoglycemia are outlined in Supplementary Figure 1. […] Infants with hypoglycemia persisting beyond the first 72 hours post-birth should be investigated further when glucose levels remain 2.8 mmol/L. A critical sample should be collected. […] A higher threshold for investigation of 2.8 mmol/L, and 3.3 mmol/L as the therapeutic target, are recommended after the transitional period. […] Screening, monitoring, and intervention protocols have been revised to better identify, manage, and treat infants who are at risk for persistent, recurrent, or severe hypoglycemia.

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