Hypoglycemia Among Patients with Type 2 Diabetes: Epidemiology, Risk Factors, and Prevention Strategies

Abstract

Purpose of Review

Hypoglycemia is the most common and often treatment-limiting serious adverse effect of diabetes therapy. Despite being potentially preventable, hypoglycemia in type 2 diabetes incurs substantial personal and societal burden. We review the epidemiology of hypoglycemia in type 2 diabetes, discuss key risk factors, and introduce potential prevention strategies.

Recent Findings

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. Patient-reported hypoglycemia is much more common. Over the course of 6 months, 1–4% non-insulin users reported need for medical attention for hypoglycemia; 1–17%, need for any assistance; and 46–58%, any hypoglycemia symptoms. Similarly, over a 12-month period, 4–17% of insulin-treated patients reported needing assistance and 37–64% experienced any hypoglycemic symptoms. 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. 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.

Summary

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.

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Acknowledgments

We sincerely appreciate the valuable contributions of Nataly R. Espinoza Suarez, MD, for her work on the study screening and review. We further extend our sincere thanks to Patricia J. Erwin, MLS (Mayo Clinic Library), for assisting with the comprehensive literature search and to Bryce Bergene (Mayo Clinic Brand Strategy and Creative Studio) for assisting with the creation of the figure graphics.

Funding

Dr. McCoy is supported by the Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery and the National Institute of Diabetes and Digestive and Kidney Diseases of the National Institutes of Health under Award Number K23DK114497. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

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Correspondence to Rozalina G. McCoy.

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Richard Silbert, Alejandro Salcido-Montenegro, Rene Rodriguez-Gutierrez, and Abdulrahman Katabi declare that they have no conflict of interest.

Rozalina G. McCoy reports a consulting fee from Dexcom paid to her institution (2016).

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This article does not contain any studies with human or animal subjects performed by any of the authors.

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This article is part of the Topical Collection on Diabetes Epidemiology

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Silbert, R., Salcido-Montenegro, A., Rodriguez-Gutierrez, R. et al. Hypoglycemia Among Patients with Type 2 Diabetes: Epidemiology, Risk Factors, and Prevention Strategies. Curr Diab Rep 18, 53 (2018). https://doi.org/10.1007/s11892-018-1018-0

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Keywords

  • Type 2 diabetes mellitus
  • Hypoglycemia
  • Epidemiology
  • Patient-reported outcome
  • Patient-centered care