Unrecognized risk factors for severe hypoglycemia outlined in insulin-treated type 2 diabetes
An industry-funded case-control study of data from a U.S. administrative claims database found that pregnancy, alcohol misuse, short or rapid-acting insulin, and smoking, among other conditions and medications, were independently associated with increased risk.
Certain diseases, conditions, and medications may increase risk for severe hypoglycemia in adults with type 2 diabetes who are taking insulin, a recent study found.
Researchers performed a case-control study using an administrative claims database of U.S. adults with type 2 diabetes who were starting insulin. Cases were patients who had a severe hypoglycemia event, and controls were patients who did not have an event but were at risk for same amount of time. Conditional logistic regression was used to evaluate previously unreported risk factors for severe hypoglycemia, after exact matching on established risk factors. The study was funded by Eli Lilly and Company, and several authors were employed by Eli Lilly or by the database company. The results were published March 9 by Diabetes, Obesity and Metabolism.
A total of 3,153 case-control pairs were included in the study. The mean age for cases and controls was 57 years, and the mean time at risk before a severe hypoglycemic event was 11.2 months. An independent association was seen between severe hypoglycemia and many previously unreported risk factors. Diseases or conditions with an independent association included pregnancy (odds ratio [OR], 3.20; P=0.0003); cancer (OR, 1.87; P<0.0001); dementia/Alzheimer's disease (OR, 1.73; P=0.0175); peripheral vascular disease (OR, 1.59; P<0.0001); paralysis, hemiplegia, and paraplegia (OR, 1.51; P=0.0416); hepatitis (OR, 1.50; P=0.0303); congestive heart failure (OR, 1.47; P=0.0002); cardiac arrhythmia (OR, 1.29; P=0.0065); liver, gallbladder, and pancreatic disease (OR, 1.26; P=0.0182); and hypertension (OR, 1.19; P=0.0164). Medications included short- and rapid-acting insulin (ORs, 2.22 and 1.47; P<0.0001), antipsychotics (OR, 1.59; P=0.0059), anxiolytics (OR, 1.51; P=0.0012), adrenergic-corticosteroid combinations (OR, 1.45; P=0.0165), beta-adrenoceptor agonists (OR, 1.40; P=0.0225), opioids (OR, 1.38; P<0.0001), and corticosteroids (OR, 1.35; P=0.0159). Alcohol misuse (OR, 2.43; P<0.0001), smoking (OR, 1.28; P=0.005), and Charlson Comorbidity Index scores of 2, 3, or 4 and above (OR, 1.28 [P=0.0026], 1.41 [P=0.0016], and 1.57 [P=0.0002]) were also independently associated with severe hypoglycemia.
The researchers noted that the claims data used for their study did not include information on behavioral, dietary, and socioeconomic factors and that their results are not generalizable to uninsured patients or those with different types of insurance, among other limitations. They concluded that their results indicate some potentially unrecognized risk factors for severe hypoglycemia among adults with insulin-treated type 2 diabetes mellitus and said that physicians should take a detailed history of comorbid conditions in the previous six months, as well as recent or current medication use, to identify those at higher risk.
“People who have any of these factors may require additional glucose monitoring, be provided with rescue medication and, along with their relatives or caregivers, receive detailed education about hypoglycaemia. This would include how to take preventative measures to reduce the risk, how to recognise the early symptoms of hypoglycaemia to permit early intervention, how to treat non-severe and severe hypoglycaemia, and how to avoid its recurrence,” the authors wrote. “Finally, healthcare providers should exercise caution and balance risk when proposing intensive insulin regimens for smokers/exsmokers, those with heavy alcohol consumption, and pregnant women, in view of the enhanced risk of severe hypoglycaemia and ensure that these patients receive appropriate education.”