- A new tool developed predicts hospitalization of type 2 diabetes for severe hypoglycemia
- Hypoglycemia risk stratification tool predicts a patient's 12-month risk of hypoglycemia-related emergency department or hospital utilization
- With improved health care and treatment, the risk of long-term complications and death can be reduced
A new practical tool has been developed, which aids in identifying diabetes patients who are at an increased risk for being admitted to an emergency department or hospital due to severe hypoglycemia (very low blood sugar), reveals a new study led by Kaiser Permanente.
The risk of long-term complications and death were found to be reduced in more than 25 million Americans, who have diabetes with advances in care and improved treatment.
‘The aim is to identify patients at higher risk for hypoglycemia and to cater to the specific needs of these patients to reduce and prevent hypoglycemia harm.’
Sometimes, patients experienced dangerously low blood sugar levels even while taking diabetes medications, particularly after skipping a meal or exercising much harder than usual. The results were published in JAMA Internal Medicine.
Hypoglycemia is often Preventable
Andrew J. Karter, PhD, senior research scientist with the Kaiser Permanente Division of Research and the study's lead author said, "Sometimes a person with diabetes is unaware that their blood sugar is dropping and can progress quickly into severe hypoglycemia, which has been associated with falls, automobile accidents, heart attacks, coma, and even death."
With proper clinical attention, hypoglycemia is often preventable and the new tool developed is believed to help focus on the patients who most need it.
In the United States, hypoglycemia has now become one of the most frequent adverse events in patients with type 2 diabetes.
Every year, an estimated 100,000 hypoglycemia-related adverse events result in emergency room visits. Especially, patients who are older and who have a longer history of diabetes are more susceptible, says Karter.
The hypoglycemia risk stratification tool was developed by the research team by identifying 156 possible risk factors for hypoglycemia. They also collected data from more than 200,000 patients, who had type 2 diabetes and were receiving care from Kaiser Permanente in Northern California.
The research used machine-learning analytical techniques and have developed a model, which can predict a patient's 12-month risk of hypoglycemia-related emergency department or hospital use.
The final model made was based on the following six variables:
- use of insulin;
- use of sulfonylurea (an oral medication commonly used to treat diabetes);
- severe or end-stage kidney disease;
- number of emergency room visits for any reason in the past year;
- number of prior episodes of hypoglycemia-related emergency department visits or hospitalizations;
The research team created a practical tool based on the model to categorize patients into high (greater than 5 percent), intermediate (1 to 5 percent) or low (less than 1 percent) annual risk of the hypoglycemia-related emergency department or hospital use.
The research team validated the tool with data collected from more than 1.3 million members of the U.S. Veterans Health Administration and about 15,000 Kaiser Permanente members with type 2 diabetes in Washington state.
The U.S. Food and Drug Administration (FDA) funded for the development of the tool to identify patients at risk of hypoglycemia under their Safe Use Initiative, which is a collaborative effort to reduce adverse events related to medication use, including medications related to diabetes that is linked to increasing the risk of hypoglycemia.
The results are being circulated widely with help from the Centers for Medicare and Medicaid Services (CMS).
Several public and private health care systems and organizations including CMS, Kaiser Permanente, and the Mayo Clinic are now examining how this tool can be used to increase awareness about hypoglycemia and provide resources to aid patients with type 2 diabetes avoid dangerous episodes shortly.
John Whyte, MD, MPH, Director of Professional Affairs and Stakeholder Engagement for the FDA said, "This work is an example of how federal agencies can work with private researchers to reduce preventable adverse drug events."
The goal of this study is to identify patients who are at an increased risk for hypoglycemia so that health care providers can focus their attention and cater to the specific needs of these patients and thereby, reduce preventable hypoglycemia harm, said Whyte.
What is Hypoglycemia?
Hypoglycemia or low blood sugar in diabetic patients is a paradox since diabetes is characterized by high glucose levels in the blood. However, people with diabetes who are on insulin or certain oral hypoglycemic drugs can suffer from low blood sugar.
Hypoglycemia usually happens if the patient has taken a higher than normal dose of insulin or oral medication or if the patient has skipped a meal or has undergone excessive physical activity. Patients with type 1 diabetes are particularly prone to hypoglycemic episodes.
If hypoglycemia is left untreated, it can cause permanent brain damage. Therefore, treating low blood sugar should be considered an emergency. Immediate treatment of hypoglycemia involves the use of oral glucose or sugar or candy, whichever is available at hand.
- Andrew J. Karter, E. Margaret Warton, Kasia J. Lipska, James D. Ralston, Howard H. Moffet, Geoffrey G. Jackson, Elbert S. Huang, Donald R. Miller. Development and Validation of a Tool to Identify Patients With Type 2 Diabetes at High Risk of Hypoglycemia-Related Emergency Department or Hospital Use. JAMA Internal Medicine (2017).DOI: 10.1001/jamainternmed.2017.3844