Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2018 Jun 21;18(8):53.
doi: 10.1007/s11892-018-1018-0.

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

Richard Silbert  1 , Alejandro Salcido-Montenegro  2   3 , Rene Rodriguez-Gutierrez  2   3   4 , Abdulrahman Katabi  5 , Rozalina G McCoy  6   7
Affiliations
Review

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

Richard Silbert et al. Curr Diab Rep. .

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. 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.

Keywords: Epidemiology; Hypoglycemia; Patient-centered care; Patient-reported outcome; Type 2 diabetes mellitus.

PubMed Disclaimer

Conflict of interest statement

Conflict of Interest

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).

Figures

Figure 1.
Figure 1.. Risk factors for hypoglycemia among patients with type 2 diabetes.
DSME, diabetes self-management education. EHR, electronic health records. HbA1c, hemoglobin A1c. PROs, patient-reported outcomes.
Figure 2.
Figure 2.. Strategies to reduce hypoglycemia risk among patients with type 2 diabetes.
DSME, diabetes self-management education. EHR, electronic health records. HbA1c, hemoglobin A1c. PHR, patient health records. PROs, patient-reported outcomes.
See this image and copyright information in PMC

References

    1. CDC. National Diabetes Statistics Report, 2017: Estimates of Diabetes and Its Burden in the United States. Centers for Disease Control and Prevention. National Center for Chronic Disease Prevention and Health Promotion. 2017. https://www.cdc.gov/diabetes/pdfs/data/statistics/national-diabetes-stat.... Accessed January 21 2018.
    1. WHO . World Health Organization Global Report on Diabetes. World Health Organization, Geneva, Switzerland: 2016. http://apps.who.int/iris/bitstream/10665/204871/1/9789241565257_eng.pdf?.... Accessed February 26 2018.
    1. Holmes HM, Hayley DC, Alexander GC, Sachs GA. Reconsidering medication appropriateness for patients late in life. Arch Intern Med. 2006;166(6):605–9. doi:10.1001/archinte.166.6.605. - DOI - PubMed
    1. Cryer PE. Hypoglycemia: still the limiting factor in the glycemic management of diabetes. Endocr Pract. 2008;14(6):750–6. doi:10.4158/EP.14.6.750. - DOI - PubMed
    1. Zoungas S, Patel A, Chalmers J, de Galan BE, Li Q, Billot L et al. Severe hypoglycemia and risks of vascular events and death. N Engl J Med. 2010;363(15):1410–8. doi:10.1056/NEJMoa1003795. - DOI - PubMed

    2. This post-hoc analysis of the ADVANCE trial examined the patient- and treatment-specific risk factors for hypoglycemia. Furthermore, this study found that severe hypoglycemia, irrespective of the study arm, significantly increased the risks of all-cause mortality (HR 2.69; 95% CI, 1.97-3.67), cardiovascular mortality (HR 2.68; 95% CI, 1.72-4.19), major macrovascular events (HR 2.88; 95% CI, 2.01-4.12), and major microvascular events (HR 1.81; 95% CI, 1.19-2.74)

Publication types

MeSH terms

LinkOut - more resources