HealthDay News – Intensive diabetes treatment nearly doubles the risk of severe hypoglycemia requiring medical attention in clinically complex patients, according to a study published online June 6 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.

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,” Dr McCoy said in a Mayo news release.

References

  1. Kerr EA, Hofer TP. Deintensification of routine medical services. The next frontier for improving care quality. JAMA Intern Med. 2016. doi: 10.1001/jamainternmed.2016.2292.
  2. McCoy RG, Lipska KJ, Yao X, Ross JS, Montori VM, Shah ND. Intensive treatment and severe hypoglycemia among adults with type 2 diabetes. JAMA Intern Med. 2016. doi: 10.1001/jamainternmed.2016.2275.