Hypoglycemia Up With Intensive Glucose-Lowering Therapy

Intensive glucose-lowering therapy is prevalent among U.S. adults with diabetes and results in hospitalizations and emergency department visits for hypoglycemia, according to a study published online in the Mayo Clinic Proceedings.

Grace K. Mahoney, from Harvard Medical School in Boston, and colleagues examined the prevalence of intensive glucose-lowering therapy among U.S. adults with diabetes and glycated hemoglobin (HbA1c) levels <7.0 percent between 2011 and 2014. Participants aged ≥75 years or with two or more activities-of-daily-living limitations, end-stage renal disease, or three or more chronic conditions were categorized as clinically complex. Any glucose-lowering medication with HbA1c levels of ≤5.6 percent or two or more with HbA1c levels of 5.7 to 6.4 percent was defined as intensive treatment.

The researchers found that 48.8 percent of U.S. adults with diabetes had HbA1c levels less than 7.0 percent. Of these, 32.3 percent were clinically complex and 21.6 percent were intensively treated; there was no difference in intensive treatment by clinical complexity. In this population, there were an estimated 31,511 hospitalizations and 30,954 emergency department visits for hypoglycemia over a two-year period; of these, 4,774 and 4,804, respectively, were attributable to intensive treatment.

"Intensive treatment with glucose-lowering therapy remains common," the authors write. "There is also no apparent individualization of therapy based on patient clinical complexity, life expectancy, or the likelihood of benefit from targeting low HbA1c levels."

The study was supported by OptumLabs.

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