Epidemiology

​Diabetic hypoglycemia is a common complication of diabetes both in the US and globally.[1][6][7][8] Hypoglycemia occurs most commonly in people with type 1 diabetes.[1][2][8][9] However, be aware that hypoglycemia can occur in people with type 2 diabetes due to treatment with insulin or insulin secretagogs (sulfonylureas and meglitinides).[1][2][8][9] The total number of hypoglycemic 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 hypoglycemia 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 hypoglycemia 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 hospitalization 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 hypoglycemia, with an incidence that is similar to people with type 1 diabetes.[13][14]​​[15][16] Older adults, particularly those ages >60 years, have higher rates of hypoglycemia than younger adults.[1][2][3][17][18][19] Young children also have higher rates of hypoglycemia than young adults.[1][2][3]​ There is no clear difference between men and women and incidence of hypoglycemia.

Incidence of diabetic hypoglycemia increases in early pregnancy, particularly at around 10-15 weeks' gestation.​[20][21][22][23][24]​​​​​​​​​​​​​ In pregnant women with preexisting type 1 diabetes, severe hypoglycemia occurs around 3-5 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 hypoglycemia have been reported as high as 19% to 44% in pregnant women who are treated with intensive insulin therapy.[26]

Episodes of hypoglycemia are typically underreported, 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 hypoglycemic 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 hypoglycemia in people with diabetes over time. One study estimated the age- and sex-standardized rate of severe hypoglycemia 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 hypoglycemia during this period had not changed.[28] However, there is increasing evidence to suggest that the rates of severe hypoglycemia in children have declined in developed countries.[29][30][31]

Use of this content is subject to our disclaimer