Identifying Patients with Type 2 Diabetes at Risk for Hypoglycemia

Diabetes


Diabetes researchers developed a tool that utilizes six factors to categorize the risk of admission to the hospital or emergency department due to hypoglycemia.

Type 2 diabetes is a disease that usually presents as high blood sugar levels, along with other signs and symptoms. Some medications prescribed to manage this condition can cause blood sugar levels to drop too low. This is known as hypoglycemia. Examples of medication classes which may cause hypoglycemia include insulin and sulfonylureas. Previous studies have indicated that hypoglycemia is one of the most common adverse drug reactions in patients with type 2 diabetes. It is also known to increase the probability of falls, car accidents, and death, when severe.

Diabetes researchers wanted to know if electronic medical records (EMR) could reliably be used to predict the risk of future hypoglycemia-related emergency room visits in patients with diabetes.  The study was recently published in JAMA Internal Medicine. The study participants were divided into two groups: development group and the validation group. There were 206,435 total participants from the Kaiser Permanente Northern California (KPNC) health care system. There were 165,148 participants in the development group.  The EMR identified these patients as being diagnosed with type 2 diabetes and the outcome was based on admission due to hypoglycemia. Patients who developed hypoglycemia during their admission were excluded. The tool was validated by analyzing patient data from KPNC, Veterans Health Administration, and Group Health Cooperative.

The resulting tool categorizes the 12-month risk of a patient being admitted to the hospital or emergency department due to hypoglycemia. It comprises six patient factors, chosen for their ease of use. These factors are:

  1. number of prior episodes of hypoglycemia-related hospital/emergency admissions
  2. insulin use
  3. sulfonylurea use
  4. previous year emergency room admissions
  5. chronic kidney disease stage (stages 4 and 5 relevant for this purpose)
  6. age

On the basis of these criteria, the 12-month risk can be classified as low risk, intermediate risk, and high risk. There were a few limitations to this study as noted in the article. One of these was the exclusion of all other causes of hospital/emergency department admission. As previously mentioned, hypoglycemia can be a contributing factor to a car accident. Therefore, if a person was admitted to the hospital due to a car accident and hypoglycemia was found to be the root cause, their data would not have been included in the study.

The ability to assess the risk of hospitalization due to hypoglycemia in patients with type 2 diabetes is important and can be a helpful addition to a healthcare professional’s repertoire. It could potentially help reduce the number of hospital visits due to this adverse drug event. It facilitates an open discussion with the patient to determine reasons that may be contributing to hypoglycemic episodes. It also helps empower the patient to be more aware of their medical condition and its management.

Written by Anuolu Bank-Oni, Pharm.D, CDE

Reference:

Karter AJ, Warton EM, Liska KJ, Ralston JD, Mofet HH, Jackson GG, Huang ES, Miller DR. 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 Intern Med 2017 Aug 21



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