Good News, Bad News, on Hypoglycemia in Diabetes in UK

Marlene Busko

August 01, 2016

The number of diabetic patients who are hospitalized for hypoglycemia each year in England has increased over the past decade, but more recently, the numbers have decreased, new research reveals.

Specifically, from 2005 to 2014, the rate of hospitalizations for hypoglycemia increased by 14%. However, a closer look showed that the rate increased until 2010 and then fell. For every 1000 patients with diabetes, 4.6 were hospitalized for hypoglycemia in 2010, but only 3.9 were hospitalized for hypoglycemia in 2014.

The study, by Francesco Zaccardi, MD, a clinical research fellow at the Leicester Diabetes Centre, University of Leicester, United Kingdom, and colleagues, was recently published online in Lancet Diabetes & Endocrinology.

The findings "are both 'positive' and 'negative,' " Dr Zaccardi told Medscape Medical News in an email. The bad news is that the number of diabetic patients is increasing, and the number of hospitalizations for hypoglycemia was higher at the end of the decade than at the start.

The good news is that there are "signs of stabilization" in the proportion of patients with diabetes who end up in the emergency room with hypoglycemia and are subsequently admitted to the hospital, according to Dr Zaccardi.

Moreover, the rate of same-day hospital discharge has been steadily increasing and rates of in-hospital mortality and readmission within a month have been steadily decreasing — suggesting that in-hospital care and early glycemic control after hospital discharge have been improving over the study period.

Nevertheless, the study highlights the need for even greater efforts to better control blood glucose levels.

Given the aging population, the rising prevalence of diabetes, and the risk of hypoglycemia with too-tight glycemic control in older diabetic patients, "further efforts are required to avoid an increase in hospital admissions" for hypoglycemia in the near future, Dr Zaccardi said.

10-Year Hypoglycemia Trend in England

Studies in the United States and Canada that have looked at trends in hospital admissions for hypoglycemia have reported finding no trend or a peak followed by a decline or a continuous decline. But until now, no study has examined trends based on national data for hypoglycemia hospitalizations in England.

The researchers aimed to investigate this using data from 2005 to 2014 from the Hospital Episode Statistics (HES) database, which contains data for all admissions to English National Health Service (NHS) hospitals.

Between January 1, 2005 and December 31, 2014, a total of 79,172 people were admitted to the hospital in England for 101,475 episodes of severe hypoglycemia. In almost three-quarters of the cases (72%), the patients were 60 or older.

After adjustment for sex, ethnic group, deprivation index, and Charlson comorbidity score, the relationship between patient age and the likelihood of admission for hypoglycemia was J-shaped.

Compared with patients aged 20 to 49, the risk of being hospitalized for severe hypoglycemia was higher in patients younger than 20, and it increased with increasing age in people who were 50 and older.

The younger patients would be expected to have type 1 diabetes and hypoglycemia that was due to an imbalance between insulin dose and their need for insulin, depending on their meals and activity level, Dr Zaccardi said. On the other hand, the patients aged 50 and older would almost all have type 2 diabetes, and their hypoglycemia might be related to an intensive glucose-lowering strategy.

During the decade, 82% of patients were admitted once to the hospital for hypoglycemia; 12% were admitted twice; and the rest were admitted more often.

Shorter Hospital Stay, Lower In-Hospital Death, Lower Readmission

From 2005 to 2010, annual hospital admissions for hypoglycemia rose from 7868 to 11,756 (a 49% increase), but from 2010 to 2014, they decreased from 11,756 to 10,977 (a 7% decrease).

Thus, overall, hospital admissions for hypoglycemia increased by 39% during the decade. There were large regional variations in hypoglycemia hospitalization rates — from an increase of 11% in the East Midlands to an increase of 89% in London.

On the positive side, adjusted same-day discharge increased from 19% to 27% (a 44% rise) and in-hospital mortality decreased from 4.2 deaths per 100 admissions to 2.3 deaths per 100 admissions (a 46% drop) during this decade

Similarly, 1-month readmissions decreased from 48 per 100 discharges to 18 per 100 discharges (a 63% drop) — all adjusted for age, sex, ethnic group, deprivation index, and Charlson comorbidity score.

During the most recent 4 years, the prevalence of diabetes in people aged 17 and older increased by 15%, but hospital admissions for hypoglycemia decreased by 4%.

This study highlights the need for more research to find ways to further reduce the incidence of severe hypoglycemia episodes to be able to lower healthcare costs and improve patient quality of life, Dr Zaccardi and colleagues conclude.

Dr Zaccardi is a clinical research fellow funded with an unrestricted educational grant from Sanofi to the University of Leicester. Disclosures for the coauthors are listed in the article.

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Lancet Diabetes Endocrinol. Published online June 9, 2016. Abstract

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