The American Journal of Managed Care October 2011
The Incidence and Costs of Hypoglycemia in Type 2 Diabetes
The overall rate of hypoglycemia requiring medical intervention was 153.8 hypoglycemic episodes per 10,000 p-yrs among patients with type 2 diabetes taking at least 1 OAD.The rate of hypoglycemia was highest in youngest (18-34 years) and older (65 years) patients and higher in women than men. The total costs associated with medical visits and hospitalizations for hypoglycemia were in excess of $52 million (2008 dollars; $30,930,649 for inpatient, $6,606,733 for ED, and $14,686,293 for outpatient visits). Further, the total costs of all hypoglycemia-related inpatient admissions exceeded the costs of all hypoglycemia-related ED and outpatient visits combined. Younger adults and women with type 2 dia-betes may require more assistance to prevent hypoglycemic episodes. Continued vigilance for the occurrence and costs of hypoglycemia in patients with type 2 diabetes is essential. As hypoglycemia remains an important barrier to medication treatment of type 2 diabetes, strategies to decrease the incidence of hypoglycemia are needed.
Author Affiliations: From College of Pharmacy (BJQ, JCS, ABO, SJK), University of Rhode Island, Kingston, RI.
Funding Source: This research was funded by a grant from Takeda Pharmaceuticals America, Inc.
Author Disclosures: Dr Quilliam reports consultancies or paid advisory boards from OMJ Scientific Affairs. He and Dr Simeone have received grants from Takeda Pharmaceuticals America, Inc, and both have received payment for involvement in the preparation of this manuscript as part of a grant study funded by Takeda. Dr Kogut has received grants from Takeda Pharmaceuticals. Dr Ozbay reports no relationship or financial interest with any entity that would pose a conflict of interest with the subject matter of this article.
Authorship Information: Concept and design (BJQ, JCS, ABO, SJK); acquisition of data (BJQ, SJK); analysis and interpretation of data (BJQ, JCS, ABO); drafting of the manuscript (BJQ, JCS); critical revision of the manuscript for important intellectual content (BJQ, JCS); statistical analysis (BJQ, JCS, ABO); obtaining funding (BJQ, SJK); and administrative, technical, or logistic support (SJK).
Address correspondence to: Brian J. Quilliam, PhD, College of Pharmacy, University of Rhode Island, 41 Lower College Rd, Kingston, RI 02881. E-mail: firstname.lastname@example.org.
1. Greco D, Pisciotta M, Gambina F, Maggio F. Severe hypoglycaemia leading to hospital admission in type 2 diabetic patients aged 80 years or older. Exp Clin Endocrinol Diabetes. 2010;118(4):215-219.
2. Gottschalk M, Danne T, Vlajnic A, Cara JF. Glimepiride versus metformin as monotherapy in pediatric patients with type 2 diabetes: a randomized, single-blind comparative study. Diabetes Care. 2007;30(4): 790-794.
3. Sugarman JR. Hypoglycemia associated hospitalizations in a population with a high prevalence of non-insulin-dependent diabetes mellitus. Diabetes Res Clin Pract. 1991;14(2):139-147.
4. Cox DJ, Gonder-Frederick L, Ritterband L, Clarke W, Kovatchev BP. Prediction of severe hypoglycemia. Diabetes Care. 2007;30(6): 1370-1373.
5. Garber AJ, Schweizer A, Baron MA, Rochotte E, Dejager S. Vildagliptin in combination with pioglitazone improves glycaemic control in patients with type 2 diabetes failing thiazolidinedione monotherapy: a randomized, placebo-controlled study. Diabetes Obes Metab. 2007; 9(2):166-174.
6. Alvarez Guisasola F, Tofe Povedano S, Krishnarajah G, Lyu R, Mavros P, Yin D. Hypoglycaemic symptoms, treatment satisfaction, adherence and their associations with glycaemic goal in patients with type 2 diabetes mellitus: findings from the Real-Life Effectiveness and Care Patterns of Diabetes Management (RECAP-DM) Study. Diabetes Obes Metab. 2008;10(suppl 1):25-32.
7. Zammitt NN, Frier BM. Hypoglycemia in type 2 diabetes: pathophysiology, frequency, and effects of different treatment modalities. Diabetes Care. 2005;28(12):2948-2961.
8. Leese GP, Wang J, Broomhall J, et al. Frequency of severe hypoglycemia requiring emergency treatment in type 1 and type 2 diabetes: a population-based study of health service resource use. Diabetes Care. 2003;26(4):1176-1180.
9. Hammer M, Lammert M, Mejias SM, Kern W, Frier BM. Costs of managing severe hypoglycaemia in three European countries. J Med Econ. 2009;12(4):281-290.
10. Holstein A, Plaschke A, Egberts EH. Incidence and costs of severe hypoglycemia. Diabetes Care. 2002;25(11):2109-2110.
11. Jonsson L, Bolinder B, Lundkvist J. Cost of hypoglycemia in patients with Type 2 diabetes in Sweden. Value Health. 2006;9(3):193-198.
12. Lundkvist J, Berne C, Bolinder B, Jonsson L. The economic and quality of life impact of hypoglycemia. Eur J Health Econ. 2005;6(3): 197-202.
13. Curkendall SM, Natoli JL, Alexander CM, Nathanson BH, Haidar T, Dubois RW. Economic and clinical impact of inpatient diabetic hypoglycemia. Endocr Pract. 2009;15(4):302-312.
14. Rhoads GG, Orsini LS, Crown W, Wang S, Getahun D, Zhang Q. Contribution of hypoglycemia to medical care expenditures and shortterm disability in employees with diabetes. J Occup Environ Med. 2005;47(5):447-452.
15. Pelletier EM, Smith PJ, Boye KS, Misurski DA, Tunis SL, Minshall ME. Direct medical costs for type 2 diabetes mellitus complications in the US commercial payer setting: a resource for economic research. Appl Health Econ Health Policy. 2008;6(2-3):103-112.
16. Boyle JP, Thompson TJ, Gregg EW, Barker LE, Williamson DF. Projection of the year 2050 burden of diabetes in the US adult population: dynamic modeling of incidence, mortality, and prediabetes prevalence. Popul Health Metr. 2010;8(1):29.
17. Adamson DM, Chang S, Hansen LG. Health research data for the real world: the Marketscan databases. New York, NY: Thompson Healthcare; 2008.
18. MarketScan User Guide. Ann Arbor, MI: Thomson Reuters; 2007.
19. Meduru P, Helmer D, Rajan M, Tseng C, Pogach L, Sambamoorthi U. Chronic illness with complexity: implications for performance measurement of optimal glycemic control. J Gen Intern Med. 2007;22 (suppl 3):408-418.
20. Ginde AA, Blanc PG, Lieberman RM, Camargo CA Jr. Validation of ICD-9-CM coding algorithm for improved identification of hypoglycemia visits. BMC Endocr Disord. 2008;8:4.
21. Perrins G, Nilsen D. Math Calculations to Better Utilize CPI Data. Bureau of Labor Statistics. http://www.bls.gov/cpi/cpimathfs.pdf. Published 2007. Accessed September 20, 2011.
22. Vlckova V, Cornelius V, Kasliwal R, Wilton L, Shakir SA. Hypoglycaemia with oral antidiabetic drugs: results from prescription-event monitoring cohorts of rosiglitazone, pioglitazone, nateglinide andxrepaglinide. Drug Saf. 2009;32(5):409-418.
23. Bodmer M, Meier C, Krahenbuhl S, Jick SS, Meier CR. Metformin, sulfonylureas, or other antidiabetes drugs and the risk of lactic acidosis or hypoglycemia: a nested case-control analysis. Diabetes Care. 2008;31(11):2086-2091.
24. Group UHS. Risk of hypoglycaemia in types 1 and 2 diabetes: effects of treatment modalities and their duration. Diabetologia. 2007; 50(6):1140-1147.
25. Holstein A, Plaschke A, Egberts EH. Lower incidence of severe hypoglycaemia in patients with type 2 diabetes treated with glimepiride versus glibenclamide. Diabetes Metab Res Rev. 2001;17(6):467-473.
26. Stahl M, Berger W. Higher incidence of severe hypoglycaemia leading to hospital admission in Type 2 diabetic patients treated with longacting versus short-acting sulphonylureas. Diabet Med. 1999;16(7): 586-590.
27. van Staa T, Abenhaim L, Monette J. Rates of hypoglycemia in users of sulfonylureas. J Clin Epidemiol. 1997;50(6):735-741.
28. Shorr RI, Ray WA, Daugherty JR, Griffin MR. Individual sulfonylureas and serious hypoglycemia in older people. J Am Geriatr Soc. 1996;44(7):751-755.
29. Rhoads GG, Orsini LS, Crown W, Wang S, Getahun D, Zhang Q. Contribution of hypoglycemia to medical care expenditures and shortterm disability in employees with diabetes. J Occup Environ Med. 2005;47(5):447-452.
30. Lin EH, Rutter CM, Katon W, et al. Depression and advanced complications of diabetes: a prospective cohort study. Diabetes Care. 2010;33(2):264-269.