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      Incidence rate and patient characteristics of severe hypoglycemia in treated type 2 diabetes mellitus patients in Japan: Retrospective Diagnosis Procedure Combination database analysis

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          Abstract

          Aims/Introduction

          To evaluate the incidence rate of and identify factors associated with severe hypoglycemic episodes in patients with treated type 2 diabetes mellitus.

          Materials and Methods

          Using Diagnosis Procedure Combination hospital‐based medical database, we carried out a retrospective cohort study to assess the incidence rate of severe hypoglycemia in treated type 2 diabetes mellitus patients. We evaluated the associations between severe hypoglycemia and age, sex, complications, and current use of insulin or sulfonylurea (SU) in a nested case–control study.

          Results

          Of 166,806 eligible patients, 1,242 had episodes of severe hypoglycemia during the observational period. The incidence rate of the first hypoglycemic events was 3.70/1,000 patient years. Based on the nested case–control analysis, age was associated with hypoglycemic events with adjusted odds ratios (ORs) of 1.64 or 65–74‐year‐old patients and 3.79 for ≥75‐year‐old patients in comparison with 20–64‐year‐old patients. Comorbidities, such as cognitive impairment, cancer, macrovascular disease and diabetic complications (retinopathy, nephropathy and neuropathy), were associated with severe hypoglycemia, with adjusted ORs ranging from 1.25 to 3.80. Severe hypoglycemic events also increased in patients with current use of both SU and insulin, either SU or insulin, with adjusted ORs of 18.36, 6.31 or 14.07, respectively, compared with patients with other antihyperglycemic agents. In patients with an SU glimepiride, adjusted ORs increased dose‐dependently from 3.65 (≤1 mg) to 13.34 (>2 mg).

          Conclusions

          The incidence rate of severe hypoglycemia in this cohort was 3.70/1,000 patient years. Age, cognitive impairment, cancer, diabetic complications, current use of insulin + SU and SU dosage were identified as risk factors for severe hypoglycemia.

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          Most cited references24

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          Diabetes in older adults: a consensus report.

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            Frequency of severe hypoglycemia requiring emergency treatment in type 1 and type 2 diabetes: a population-based study of health service resource use.

            To determine the incidence, predisposing factors, and costs of emergency treatment of severe hypoglycemia in people with type 1 and type 2 diabetes. Over a 12-month period, routinely collected datasets were analyzed in a population of 367,051 people, including 8,655 people with diabetes, to measure the incidence of severe hypoglycemia that required emergency assistance from Ninewells Hospital and Medical School (NHS) personnel including those in primary care, ambulance services, hospital accident and emergency departments, and inpatient care. Associated costs with these episodes were calculated. A total of 244 episodes of severe hypoglycemia were recorded in 160 patients, comprising 69 (7.1%) people with type 1 diabetes, 66 (7.3%) with type 2 diabetes treated with insulin, and 23 (0.8%) with type 2 diabetes treated with sulfonylurea tablets. Incidence rates were 11.5 and 11.8 events per 100 patient-years for type 1 and type 2 patients treated with insulin, respectively. Age, duration, and socioeconomic status were identified as risk factors for severe hypoglycemia. One in three cases were treated solely by the ambulance service with no other contact from health care professionals. The total estimated cost of emergency treatment of severe hypoglycemia was
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              Guidelines abstracted from the American Geriatrics Society Guidelines for Improving the Care of Older Adults with Diabetes Mellitus: 2013 update.

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                Author and article information

                Contributors
                Takekazu.kubo@merck.com
                Journal
                J Diabetes Investig
                J Diabetes Investig
                10.1111/(ISSN)2040-1124
                JDI
                Journal of Diabetes Investigation
                John Wiley and Sons Inc. (Hoboken )
                2040-1116
                2040-1124
                16 January 2018
                July 2018
                : 9
                : 4 ( doiID: 10.1111/jdi.2018.9.issue-4 )
                : 925-936
                Affiliations
                [ 1 ] MSD K.K. Market Access Tokyo Japan
                [ 2 ] MSD K.K. Medical Affairs Tokyo Japan
                [ 3 ] AC Medical Inc. Tokyo Japan
                Author notes
                [*] [* ] Correspondence

                Takekazu Kubo

                Tel.: +81‐3‐6272‐2338

                Fax: +81‐3‐6272‐9139

                E‐mail address: Takekazu.kubo@ 123456merck.com

                Author information
                http://orcid.org/0000-0002-5303-3186
                Article
                JDI12778
                10.1111/jdi.12778
                6031502
                29171937
                e9baa7aa-9dc6-4551-b900-4ccb938774b6
                © 2017 Merck Sharp & Dohme Corp. Journal of Diabetes Investigation published by Asian Association for the Study of Diabetes (AASD) and John Wiley & Sons Australia, Ltd

                This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc/4.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.

                History
                : 28 June 2017
                : 13 October 2017
                : 13 November 2017
                Page count
                Figures: 3, Tables: 5, Pages: 12, Words: 7956
                Funding
                Funded by: MSD K.K.
                Categories
                Original Article
                Articles
                Clinical Science and Care
                Custom metadata
                2.0
                jdi12778
                July 2018
                Converter:WILEY_ML3GV2_TO_NLMPMC version:version=5.4.1.1 mode:remove_FC converted:04.07.2018

                database analysis,hypoglycemia,type 2 diabetes
                database analysis, hypoglycemia, type 2 diabetes

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