TY - JOUR
T1 - Severe Hypoglycemia Attributable to Intensive Glucose-Lowering Therapy Among US Adults With Diabetes
T2 - Population-Based Modeling Study, 2011-2014
AU - Mahoney, Grace K.
AU - Henk, Henry J.
AU - McCoy, Rozalina G.
N1 - Funding Information:
Grant Support: This project was supported by OptumLabs. OptumLabs had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication. R.K.M. 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. Grant Support: This project was supported by OptumLabs. OptumLabs had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication. R.K.M. 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. We thank Kasia Lipska, MD, MHS (Division of Endocrinology, Yale University School of Medicine) for feedback on study design, Holly Van Houten, BA (Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery) for providing unpublished data used in the analyses, and Kelly Fust and Morgan Kruse (Optum) for helping us develop the decision analytic models. No compensation was received. Grant Support: This project was supported by OptumLabs. OptumLabs had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication. R.K.M. 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.
Publisher Copyright:
© 2019 Mayo Foundation for Medical Education and Research
PY - 2019/9
Y1 - 2019/9
N2 - Objective: To estimate the contemporary prevalence of intensive glucose-lowering therapy among US adults with diabetes and model the number of hypoglycemia-related emergency department (ED) visits and hospitalizations that are attributable to such intensive treatment. Patients and Methods: US adults with diabetes and glycated hemoglobin (HbA1c) levels less than 7.0% who were included in the National Health and Nutrition Examination Survey (NHANES) between 2011 and 2014. Participants were categorized as clinically complex if 75 years or older or with 2 or more activities of daily living limitations, end-stage renal disease, or 3 or more chronic conditions. Intensive treatment was defined as any glucose-lowering medications with HbA1c levels of 5.6% or less or 2 or more with HbA1c levels of 5.7% to 6.4%. First, we quantified the proportion of clinically complex and intensively treated individuals in the NHANES population. Then, we modeled the attributable hypoglycemia-related ED visits/hospitalizations over a 2-year period based on published data for event risk. Results: Almost half (48.8% [10,719,057 of 21,980,034]) of US adults with diabetes (representing 10.7 million US adults) had HbA1c levels less than 7.0%. Among them, 32.3% (3,466,713 of 10,719,057) were clinically complex, and 21.6% (2,309,556 of 10,719,057) were intensively treated, with no difference by clinical complexity. Over a 2-year period, we estimated 31,511 hospitalizations and 30,954 ED visits for hypoglycemia in this population; of these, 4774 (95% CI, 954-9714) hospitalizations and 4804 (95% CI, 862-9851) ED visits were attributable to intensive treatment. Conclusion: Intensive glucose-lowering therapy, particularly among vulnerable clinically complex adults, is strongly discouraged because it may lead to hypoglycemia. However, intensive treatment was equally prevalent among US adults, irrespective of clinical complexity. Over a 2-year period, an estimated 9578 hospitalizations and ED visits for hypoglycemia could be attributed to intensive diabetes treatment, particularly among clinically complex patients. Patients at risk for hypoglycemia may benefit from treatment deintensification to reduce hypoglycemia risk and treatment burden.
AB - Objective: To estimate the contemporary prevalence of intensive glucose-lowering therapy among US adults with diabetes and model the number of hypoglycemia-related emergency department (ED) visits and hospitalizations that are attributable to such intensive treatment. Patients and Methods: US adults with diabetes and glycated hemoglobin (HbA1c) levels less than 7.0% who were included in the National Health and Nutrition Examination Survey (NHANES) between 2011 and 2014. Participants were categorized as clinically complex if 75 years or older or with 2 or more activities of daily living limitations, end-stage renal disease, or 3 or more chronic conditions. Intensive treatment was defined as any glucose-lowering medications with HbA1c levels of 5.6% or less or 2 or more with HbA1c levels of 5.7% to 6.4%. First, we quantified the proportion of clinically complex and intensively treated individuals in the NHANES population. Then, we modeled the attributable hypoglycemia-related ED visits/hospitalizations over a 2-year period based on published data for event risk. Results: Almost half (48.8% [10,719,057 of 21,980,034]) of US adults with diabetes (representing 10.7 million US adults) had HbA1c levels less than 7.0%. Among them, 32.3% (3,466,713 of 10,719,057) were clinically complex, and 21.6% (2,309,556 of 10,719,057) were intensively treated, with no difference by clinical complexity. Over a 2-year period, we estimated 31,511 hospitalizations and 30,954 ED visits for hypoglycemia in this population; of these, 4774 (95% CI, 954-9714) hospitalizations and 4804 (95% CI, 862-9851) ED visits were attributable to intensive treatment. Conclusion: Intensive glucose-lowering therapy, particularly among vulnerable clinically complex adults, is strongly discouraged because it may lead to hypoglycemia. However, intensive treatment was equally prevalent among US adults, irrespective of clinical complexity. Over a 2-year period, an estimated 9578 hospitalizations and ED visits for hypoglycemia could be attributed to intensive diabetes treatment, particularly among clinically complex patients. Patients at risk for hypoglycemia may benefit from treatment deintensification to reduce hypoglycemia risk and treatment burden.
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U2 - 10.1016/j.mayocp.2019.02.028
DO - 10.1016/j.mayocp.2019.02.028
M3 - Article
C2 - 31422897
AN - SCOPUS:85071440391
SN - 0025-6196
VL - 94
SP - 1731
EP - 1742
JO - Mayo Clinic Proceedings
JF - Mayo Clinic Proceedings
IS - 9
ER -