Insulin: Lifesaver or Killer? Part 2

Clinical Consequences of Severe Hypoglycemia

In part 1 of this series, we described a scenario of a patient receiving intensive insulin therapy, and the most frequent critical complication to follow: hypoglycemia. Not only are there patient risks of severe hypoglycemia, there are clinical consequences as well.

The clinical effects of hypoglycemia include:

• Hospital admissions – In a prospective study of well-controlled elderly T2DM patients, 25% of hospital admissions for diabetes were for severe hypoglycemia.¹
• Increased mortality – In a study of severe sulfonylurea-associated hypoglycemia, 9% ended in a fatality.²
• Hospital Acquired Conditions – hypoglycemia is considered a manifestation of poor glycemic control and a Hospital-Acquired Condition for which the Centers for Medicare and Medicaid Services will not pay.³
• Economic consequences – In a retrospective analysis of 536,581 patients with type 2 diabetes from 2004 to 2008, hypoglycemia cost over 52 million dollars.⁴

Hospitals and caregivers should do what they can to avoid the above consequences. Stay tuned for part three of our series next week. We will explain the types of strategies that can be executed to minimize the risk of hypoglycemia.

References:

1. Greco D, et al. Diab Nutr Metab. 2004,17:23-26.
2. Campbell IW. Horm Metab Res Suppl. 1985,15:105-111.
3. Manifestations of Poor Glycemic Control. Changes to the Hospital Inpatient Prospective Payment Systems and Fiscal Year 2009 Rates. Department of Health and Human Services, Centers for Medicare and Medicaid Services. 42 CFR Parts 411, 412, 413, 422, and 489 (19 August 2008) pp. 48433-49084.
4. Quilliam BJ, et al. Am J Manag Care. 2011,17:673-680.