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Predictors and Consequences of Severe Hypoglycemia in Adults with Diabetes

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Predictors and Consequences of Severe Hypoglycemia in Adults with Diabetes  (April 2012)

Principal Investigator: Hanna E. Bloomfield, M.D., M.P.H.
Co-Investigators: Nancy Greer, Ph.D. David Newman, M.D. Research Associates: Roderick MacDonald, M.S. Maureen Carlyle, M.P.H. Patrick Fitzgerald, M.P.H. Indulis Rutks, B.S.

Evidence-based Synthesis Program (ESP) Center
Minneapolis VA Medical Center

Minneapolis, MN; Department of Veterans Affairs; April 2012

Download PDF: Complete Report, Executive Summary, Report, Appendices

Background

Prevalence of type 2 diabetes is increasing at an alarming pace, fueled by the rising rates of overweight and obesity in many populations. In the VA healthcare system, the prevalence of diabetes was 20% in fiscal year 2000 and is now estimated at nearly 25%.

Although people with diabetes have a substantially increased risk of cardiovascular disease (CVD), recent trials show that intensive glucose lowering does not reduce the risk of CVD death or all-cause mortality although it reduces the risk of microvascular complications (nephropathy, retinopathy and neuropathy) and possibly non-fatal myocardial infarction. Intensive glucose control also increases the risk of hypoglycemic episodes. Several recent meta-analyses of the trials comparing intensive to conventional glucose control concluded that intensive control is associated with a 2-2.5 fold increased risk of severe hypoglycemia. The reviews however have not included smaller randomized trials, trials focused on the comparison of specific drug regimens, and non-randomized trials. We conducted the current review to provide broader insight into the incidence of, the risk factors for, and the clinical and social impact of severe hypoglycemia in adults with type 2 diabetes treated with glucose lowering medications.

The key questions were as follows: In adults with type 2 diabetes treated with one or more hypoglycemic agents:

Key Question #1. What is the incidence of severe hypoglycemia in adults with type 2 diabetes on one or more hypoglycemic agents? Key Question #2. What are the risk factors for severe hypoglycemia in adults with type 2 diabetes on one or more hypoglycemic agents (e.g., demographics, co-morbidities, diabetes treatment regimen, other medication use, goal and achieved HbA1c)? Key Question #3. What is the effect of severe hypoglycemia on other outcomes in adults with type 2 diabetes on one or more hypoglycemic agents (e.g., quality of life, mortality, morbidity, utilization)?

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