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06-21-2018 | Hypoglycemia | Review | Article

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

Journal: Current Diabetes Reports

Authors: Richard Silbert, Alejandro Salcido-Montenegro, Rene Rodriguez-Gutierrez, Abdulrahman Katabi, Rozalina G. McCoy

Publisher: Springer US


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.
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•• Schroeder EB, Xu S, Goodrich GK, Nichols GA, O’Connor PJ, Steiner JF. Predicting the 6-month risk of severe hypoglycemia among adults with diabetes: development and external validation of a prediction model. J Diabetes Complicat. 2017;31(7):1158–63. https://​doi.​org/​10.​1016/​j.​jdiacomp.​2017.​04.​004. In this study, Schroeder and colleagues develop and validate two different healthcare delivery systems that are different from Karter et al. (2017) and two risk models predicting the 6-month risk of hospitalization or emergency department visit for hypoglycemia for adults with diabetes (did not differentiate by diabetes type). The full model, which included 16 variables, slightly outperformed the simplified model with six variables. The full model was comprised of patient age, race/ethnicity, diabetes type (type 1 or 2), body mass index, HbA 1c , estimated glomerular filtration rate (eGFR), any hospitalization in the past year, any emergency department visit in the past year, severe hypoglycemic event in the past year, retinopathy, cardiovascular disease, depression, heart failure, insulin, metformin, and number of classes of glucose-lowering medications. The simplified model was comprised of patient age, diabetes type, HbA 1c , eGFR, history of a hypoglycemic event in the prior year, and insulin use. PubMedPubMedCentralCrossRef
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