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Small proportion of hypoglycemia events captured by surveillance

Pharmacologically treated patients with diabetes commonly reported experiencing severe hypoglycemic events; however, health care utilization-based surveillance captured only about 5% of self-reported events, according to findings published in JAMA Internal Medicine.

“Surveillance in the United States has relied on data from [electronic medical records] or administrative claims from ED visits and hospital admissions for hypoglycemia, which are presumably the most severe and costly events,” Andrew J. Karter, PhD, from the division of research at Kaiser Permanente, and colleagues wrote. “However, this surveillance fails to account for events treated outside of the health care system (eg, by family members).”

Karter and colleagues analyzed data from the DISTANCE survey to determine how many severe hypoglycemic events are captured by surveillance based solely on health care utilization. The researchers enrolled 13,259 patients (mean age, 58.9 years; 49.4% women; 25.7% non-Hispanic white; 74.3% ethnic minorities) with diabetes — mainly type 2 diabetes — who were treated with either insulin (26.4%) or sulfonylurea (63.2%).

Data indicated that 11.7% of participants experienced one or more severe hypoglycemia events that required third party assistance within the past year. A hypoglycemic event resulting in ED or hospital utilization occurred in only 0.8% of participants. Additionally, 5.2% of participants who reported having severe hypoglycemia were admitted to the ED or hospital.

These findings suggest that “current surveillance grossly underestimates the overall burden of severe hypoglycemia,” according to Karter and colleagues.

“Because most severe hypoglycemic events occur outside of the health care system, a more complete understanding of the burden of severe hypoglycemia will require collecting self-reported events,” they wrote. “Currently, there are no validated instruments to collect these patient-reported outcome data. A brief assessment tool that reliably captures severe hypoglycemic event history should be developed and tested in clinical settings.”

“Determining the total burden of severe hypoglycemia, not just the small subset of events leading to health care utilization, will better inform clinical decision making, public health policy, and quality measure development to enhance patient safety,” they concluded. – by Alaina Tedesco

Disclosure: Karter reports receiving unrelated funding from AstraZeneca. Please see study for all other authors’ relevant financial disclosures.