(HealthDay News) — Intensive diabetes mellitus treatment nearly doubles the risk of severe hypoglycemia requiring medical attention in clinically complex patients, according to a study published online in JAMA Internal Medicine.
Rozalina McCoy, MD, an endocrinologist at the Mayo Clinic in Rochester, Minnesota, and colleagues reviewed information for 31,542 adults (median age, 58 years). All had stable and controlled type 2 diabetes without insulin treatment, and none had a prior history of severe hypoglycemia. Intensive treatment was defined as use of more glucose-lowering medications than recommended by practice guidelines per glycated hemoglobin level.
The researchers found that the risk-adjusted probability of intensive treatment was 25.7% in patients with low clinical complexity and 20.8% in patients with high clinical complexity. In patients with low clinical complexity, the risk-adjusted probability of severe hypoglycemia during the subsequent 2 years was 1.02 and 1.30% with standard and intensive treatment, respectively. In patients with high clinical complexity, the risk-adjusted probability of severe hypoglycemia increased from 1.74% to 3.04% with standard and intensive treatment, respectively.
“This means that 3 out of 100 older or clinically complex patients with diabetes who never had hypoglycemia before, whose glycated hemoglobin is within recommended targets, and who are not on insulin, will experience a severe hypoglycemic episode at some point over 2 years,” McCoy said in a Mayo news release.
1. McCoy RG, Lipska KJ, Yao X, et al. Intensive Treatment and Severe Hypoglycemia Among Adults With Type 2 Diabetes. JAMA Intern Med. doi:10.1001/jamainternmed.2016.2275.
2. Kerr EA and Hofer TP. Deintensification of Routine Medical Services The Next Frontier for Improving Care Quality. JAMA Intern Med. doi:10.1001/jamainternmed.2016.2292.