Severe hypoglycemia is a serious complication and becoming an economic burden in diabetes

Won Chul Ha, Su Jin Oh, Ji Hyun Kim, Jung Min Lee, Sang Ah Chang, Tae Seo Sohn, Hyun Shik Son, Won Chul Ha, Su Jin Oh, Ji Hyun Kim, Jung Min Lee, Sang Ah Chang, Tae Seo Sohn, Hyun Shik Son

Abstract

Background: The prevalence of hypoglycemia is increasing due to the growing incidence of diabetes and the latest strict guidelines for glycated hemoglobin (HbA1c) levels under 7%. This study examined the clinical characteristics, causal factors, and medical costs of severely hypoglycemic patients in an emergency room (ER) of Uijeongbu St. Mary's Hospital.

Methods: The study consisted of a retrospective analysis of the characteristics, risk factors, and medical costs of 320 severely hypoglycemic patients with diabetes who presented to an ER of Uijeongbu St. Mary's Hospital from January 1, 2006 to December 31, 2009.

Results: Most hypoglycemic patients (87.5%, 280/320) were over 60 years old with a mean age of 69.5±10.9 years and a mean HbA1c level of 6.95±1.46%. Mean serum glucose as noted in the ER was 37.9±34.5 mg/dL. Renal function was decreased, serum creatinine was 2.0±2.1 mg/dL and estimated glomerular filtration rate (eGFR) was 48.0±33.6 mL/min/1.73 m(2). In addition, hypoglycemic patients typically were taking sulfonylureas or insulin and a variety of other medications, and had a long history of diabetes.

Conclusion: Severe hypoglycemia is frequent in older diabetic patients, subjects with low HbA1c levels, and nephropathic patients. Therefore, personalized attention is warranted, especially in long-term diabetics with multiple comorbidities who may not have been properly educated or may need re-education for hypoglycemia.

Keywords: Cost; Diabetes mellitus; Health; Hypoglycemia.

Conflict of interest statement

No potential conflict of interest relevant to this article was reported.

Figures

Fig. 1
Fig. 1
Age distribution of severe hypoglycemia. The number of severe hypoglycemic event is increasing according to age.

References

    1. American Diabetes Association. Standards of medical care in diabetes--2012. Diabetes Care. 2012;35(Suppl 1):S11–S63.
    1. Nathan DM, Buse JB, Davidson MB, Ferrannini E, Holman RR, Sherwin R, Zinman B American Diabetes Association; European Association for the Study of Diabetes. Medical management of hyperglycaemia in type 2 diabetes mellitus: a consensus algorithm for the initiation and adjustment of therapy: a consensus statement from the American Diabetes Association and the European Association for the Study of Diabetes. Diabetologia. 2009;52:17–30.
    1. Feher MD, Grout P, Kennedy A, Elkeles RS, Touquet R. Hypoglycaemia in an inner-city accident and emergency department: a 12-month survey. Arch Emerg Med. 1989;6:183–188.
    1. Pirlich M, Lochs H. Nutrition in the elderly. Best Pract Res Clin Gastroenterol. 2001;15:869–884.
    1. Schrier RW. Diseases of the kidney and urinary tract. 8th ed. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins; 2007. Chapter 96, Metabolic and endocrine dysfunctions in uremia; pp. 2502–2539.
    1. Sobngwi E, Enoru S, Ashuntantang G, Azabji-Kenfack M, Dehayem M, Onana A, Biwole D, Kaze F, Gautier JF, Mbanya JC. Day-to-day variation of insulin requirements of patients with type 2 diabetes and end-stage renal disease undergoing maintenance hemodialysis. Diabetes Care. 2010;33:1409–1412.
    1. Holstein A, Egberts EH. Risk of hypoglycaemia with oral antidiabetic agents in patients with type 2 diabetes. Exp Clin Endocrinol Diabetes. 2003;111:405–414.
    1. Badian M, Korn A, Lehr KH, Malerczyk V, Waldhausl W. Pharmacokinetics and pharmacodynamics of the hydroxymetabolite of glimepiride (Amaryl) after intravenous administration. Drug Metabol Drug Interact. 1996;13:69–85.
    1. Lee KW. Costs of diabetes mellitus in Korea. Diabetes Metab J. 2011;35:567–570.
    1. Heaton A, Martin S, Brelje T. The economic effect of hypoglycemia in a health plan. Manag Care Interface. 2003;16:23–27.
    1. Brian MF. The economic costs of hypoglycemia. Br J Diabetes Vasc Dis. 2011;11(1 Suppl):S10–S12.
    1. Jonsson L, Bolinder B, Lundkvist J. Cost of hypoglycemia in patients with type 2 diabetes in Sweden. Value Health. 2006;9:193–198.
    1. Rhoads GG, Orsini LS, Crown W, Wang S, Getahun D, Zhang Q. Contribution of hypoglycemia to medical care expenditures and short-term disability in employees with diabetes. J Occup Environ Med. 2005;47:447–452.
    1. Reviriego J, Gomis R, Maranes JP, Ricart W, Hudson P, Sacristan JA. Cost of severe hypoglycaemia in patients with type 1 diabetes in Spain and the cost-effectiveness of insulin lispro compared with regular human insulin in preventing severe hypoglycaemia. Int J Clin Pract. 2008;62:1026–1032.

Source: PubMed

Sponsorer och medarbetare

Medicinska tillstånd

Läkemedelsinterventioner

3
Prenumerera