The European Journal of Health Economics

, Volume 6, Issue 3, pp 197–202 | Cite as

The economic and quality of life impact of hypoglycemia

  • Jonas Lundkvist
  • Christian Berne
  • Björn Bolinder
  • Linus Jönsson


Hypoglycemia is an often underrecognized side effect of type 2 diabetes therapy. This study assessed the burden of hypoglycemia in this population in Sweden and included 309 patients aged 35 years or older and treated with insulin and/or oral antidiabetic agents. Data were gathered through patient questionnaires/interviews and chart reviews. The results showed that 115 patients (37%) reported symptoms of hypoglycemia during the preceding month. Patients with hypoglycemia were more affected by their diabetes, reported lower general health, and were more anxious about hypoglycemia than those without hypoglycemia. The direct and indirect costs of hypoglycemia per patient with hypoglycemic symptoms were estimated to be U.S. $12.9 and $14.1, respectively, for a 1-month period. The results indicate that hypoglycemia is common, and that a reduction in these symptoms, without reducing glycemic control, may improve patient well-being and possibly also reduce cost.


Hypoglycemia Cost Sweden Quality of life Diabetes 


  1. 1.
    Wild S, Roglic G, Green A, Sicree R, King H (2004) Global prevalence of diabetes: estimates for the year 2000 and projections for 2030. Diabetes Care 27:1047–1053PubMedGoogle Scholar
  2. 2.
    Henriksson F, Agardh C, Berne C (2000) Direct medical costs for patients with type 2 diabetes in Sweden. J Intern Med 248:387–396Google Scholar
  3. 3.
    Henriksson F, Jonsson B (1998) Diabetes: the cost of illness in Sweden. J Intern Med 244:461–468Google Scholar
  4. 4.
    Henriksson F, Agardh CD, Berne C, Bolinder J, Jonsson B (1999) Health economics analysis of diabetes is necessary. It facilitates decision-making and international comparison. Lakartidningen 96:3915–3919Google Scholar
  5. 5.
    UK Prospective Diabetes Study (UKPDS) Group (1993) UKPDS: intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). Lancet 352:837–853Google Scholar
  6. 6.
    Diabetes Control and Complications Trial Research Group (1993) DCCT: the effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. N Engl J Med 329:977–986CrossRefPubMedGoogle Scholar
  7. 7.
    Koro CE, Bowlin SJ, Bourgeois N, Fedder DO (2004) Glycemic control from 1988 to 2000 among U.S. adults diagnosed with type 2 diabetes. Diabetes Care 27:17–20Google Scholar
  8. 8.
    Cryer PE (1999) Hypoglycemia is the limiting factor in the management of diabetes. Diabetes Metab Res Rev 15:42–46Google Scholar
  9. 9.
    Leese GP, Wang J, Broomhall J, Kelly P, Marsden A, Morrison W et al. (2003) 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 26:1176–1180Google Scholar
  10. 10.
    Miller CD, Phillips LS, Ziemer DC, Gallina DL, Cook CB, El-Kebbi IM (2001) Hypoglycemia in patients with type 2 diabetes mellitus. Arch Intern Med 161:1653–1659Google Scholar
  11. 11.
    United Kingdom Prospective Diabetes Study Group (1998) United Kingdom Prospective Diabetes Study 24: a 6-year, randomized, controlled trial comparing sulfonylurea, insulin, and metformin therapy in patients with newly diagnosed type 2 diabetes that could not be controlled with diet therapy. Ann Intern Med 128:165–175Google Scholar
  12. 12.
    Yki-Jarvinen H, Haring H, Zeger S, Arbet-Engels C, Nguyen C (2005) The relationship between HbA1c fasting blood glucose (FBG) and hypoglycaemia using insulin glragine versus NPH insulin: a meta-regression analysis in type 2 diabetes. (in press)Google Scholar
  13. 13.
    Rosenstock J, Massi Benedetti M, Haring H, Lin Z, Salzman A (2003) Confirmed lower risk of hypoglycemia with insulin glargine versus NPH insulin: a meta-analysis of 2304 patients with type 2 diabetes. Diabetologia 46: A304Google Scholar
  14. 14.
    Heller SR, Amiel SA, Mansell P (1999) Effect of the fast-acting insulin analog lispro on the risk of nocturnal hypoglycemia during intensified insulin therapy. U.K. Lispro Study Group. Diabetes Care 22:1607–1611PubMedGoogle Scholar
  15. 15.
    Heller SR (1999) Diabetic hypoglycaemia. Baillieres Best Pract Res Clin Endocrinol Metab 13:279–294Google Scholar
  16. 16.
    Brooks R (1996) EuroQol: the current state of play. Health Policy 37:53–72CrossRefPubMedGoogle Scholar
  17. 17.
    Anonymous (2003) National statistics. Statistic Sweden: StockholmGoogle Scholar
  18. 18.
    Dolan P, Roberts J (2002) Modelling valuations for EQ-5D health states: an alternative model using differences in valuations. Med Care 40:442–446Google Scholar
  19. 19.
    Cox DJ, Irvine A, Gonder-Frederick L, Nowacek G, Butterfield J (1987) Fear of hypoglycemia: quantification, validation, and utilization. Diabetes Care 10:617–621Google Scholar
  20. 20.
    Landstingsförbundet (1999) Kostnad per intagen patient (cost per admitted patient). Stockholm County Council: StockholmGoogle Scholar
  21. 21.
    Van der Does FE, De Neeling JN, Snoek FJ, Kostense PJ, Grootenhuis PA, Bouter LM et al. (1996) Symptoms and well-being in relation to glycemic control in type II diabetes. Diabetes Care 19:204–210Google Scholar
  22. 22.
    Stratton IM, Adler AI, Neil HA, Matthews DR, Manley SE, Cull CA et al. (2000) Association of glycaemia with macrovascular and microvascular complications of type 2 diabetes (UKPDS 35): prospective observational study. BMJ 321:405–412CrossRefPubMedGoogle Scholar

Copyright information

© Springer Medizin Verlag 2005

Authors and Affiliations

  • Jonas Lundkvist
    • 1
    • 4
  • Christian Berne
    • 2
  • Björn Bolinder
    • 3
  • Linus Jönsson
    • 1
  1. 1.Stockholm Health EconomicsStockholmSweden
  2. 2.Department of Internal MedicineUniversity HospitalUppsalaSweden
  3. 3.Aventis PharmaceuticalsBridgewaterUSA
  4. 4.Stockholm Health EconomicsStockholmSweden

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