Epidemiology

Diabetic hypoglycaemia is a common complication of diabetes both in the US and globally.[1][6][7][8] Hypoglycaemia occurs most commonly in people with type 1 diabetes.[1][2][8][9] However, be aware that hypoglycaemia can occur in people with type 2 diabetes due to treatment with insulin or insulin secretagogues (sulfonylureas and meglitinides).[1][2][8][9]​ The total number of hypoglycaemic events in people with type 2 diabetes who are treated with insulin may be as high as, or higher than, in people with type 1 diabetes, due to the higher overall prevalence of type 2 diabetes.[2][10]

Incidence of diabetic hypoglycaemia varies in the literature; one systematic review and meta-analysis of 72 studies showed an incidence rate of 14.5 to 42,890 episodes per 1,000 person-years in people with type 1 diabetes and 0.072 to 16,360 episodes per 1,000 person-years in people with type 2 diabetes.[6] In the US, the annual incidence of severe hypoglycaemia in patients with type 1 diabetes ranges from 3.3% to 13.5%, with around 4% of patients who are taking a basal bolus insulin regimen requiring hospitalisation at least once.[11][12] In people with type 2 diabetes, increasing duration of diabetes and treatment with insulin results in increased frequency of episodes of hypoglycaemia, with an incidence that is similar to people with type 1 diabetes.[13][14]​​[15][16] Older adults, particularly those aged >60 years, have higher rates of hypoglycaemia than younger adults.[1][2][3][17][18][19] Young children also have higher rates of hypoglycaemia than young adults.[1][2][3]​ There is no clear difference between men and women and incidence of hypoglycaemia.

Incidence of diabetic hypoglycaemia increases in early pregnancy, particularly at around 10-15 weeks' gestation.​[20][21][22][23][24]​​​​​​​​​​​​ In pregnant women with pre-existing type 1 diabetes, severe hypoglycaemia occurs around 3 to 5 times more frequently in early pregnancy (but at lower incidence in the third trimester) than in the period before pregnancy.[2][25] Incidence rates of severe hypoglycaemia have been reported as high as 19% to 44% in pregnant women who are treated with intensive insulin therapy.[26] 

Episodes of hypoglycaemia are typically under-reported, and the true incidence is likely to be higher than in the literature.[11] One study of people with type 2 diabetes showed that 75% were unaware of hypoglycaemic episodes that were detected using a continuous glucose monitoring system.[27]

Overall, evidence suggests that there has not been a significant decrease in incidence of severe hypoglycaemia in people with diabetes over time. One study estimated the age- and sex-standardised rate of severe hypoglycaemia of 1.66 million people with type 2 diabetes in the US taking antidiabetic drugs, based on data from medical and pharmacy claims between 2006 and 2013, and concluded that the rate of severe hypoglycaemia during this period had not changed.[28] However, there is increasing evidence to suggest that the rates of severe hypoglycaemia in children have declined in developed countries.[29][30][31]

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