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Hypoglycemia Can Increase Mortality at 12 Months with Diabetic Patients

Low glucose events requiring emergency services differs according to diabetes type…

Hypoglycemic episodes are a common event among patients with diabetes. Most hypoglycemic events are treated without ambulance services or admission to a hospital. However, severe hypoglycemic events are treated differently. Severe hypoglycemia is defined as “an episode requiring external assistance.” Is this definition from the paper? This is not the definition of severe hypoglycemia. Severe hypoglycemia was formerly thought to be due to endogenous insulin therapy. However, oral agents such as the sulfonylurea can cause hypoglycemia. Recent studies show that hypoglycemia is related to an increased mortality rate.

The aim of the study is to evaluate mortality at 12 months after a severe hypoglycemic episode and investigate the contributing factors to classify the people at risk. The study was designed as a cohort observational study. The data was gathered from July 2005 to April 2013. The study consisted of 34,000 participants. Logistic regression analysis was utilized to recognize predictors of 12-month mortality. The Cox proportional regression models was used to perform survival analysis.

The results showed that of 1835 episodes among 1156 patients, 45% had type 1 diabetes (68.2% males) and 44% had type 2 diabetes (49.4% males), with a minority unclassified. Of the total events, 880 patients had one single hypoglycemic episode and 276 had multiple hypoglycemic events through the study period. Glucagon was utilized in 37% of the participants diagnosed with type 1 diabetes and 28% of participants diagnosed with type 2 diabetes (p<0.0001). One-year mortality was 4.45% and 22.1% in type 1 diabetes participants and type 2 participants respectively. Contributing factors leading to mortality are age and type of diabetes. Capillary blood glucose values of hypoglycemia had no effect.

To conclude, the study showed that hypoglycemic events in diabetic patients requiring emergency services differs in the type of diabetes. Also, it demonstrated that mortality increased in patients after having a hypoglycemic event.

Practice Pearls:

  • An increase in hypoglycemic events is associated with increased mortality at 12 months.
  • Increased mortality at 12 months is associated with patients with type 2 diabetes.
  • Hypoglycemic events are common in males with type 1 diabetes.

Elwen FR, Huskinson A, Clapham L, et al. “An observational study of patient characteristics and mortality following hypoglycemia in the community.” BMJ Open Diabetes Res Care. 2015;3(1):e000094.