A model of mild hypoglycemia

Abstract

Understanding the benefit versus risk of glycemic control and hypoglycemia is fundamental to the successful management of patients with T2DM. Our validated hypoglycemia model is an important step in addressing this issue and may be helpful to researchers, clinicians, and payers to determine the patients who are at the highest risk for hypoglycemia, whether a patient is experiencing events at 'higher-than-expected' rates, and the corresponding economic burden.

Preventing Unnecessary Costs of Drug-Induced Hypoglycemia in Older Adults with Type 2 Diabetes in the United States and Canada

“…Among those receiving 2 or more glucose-lowering agents, metformin is prescribed in approximately 90% of the cases [ 15 ], suggesting that the majority of cases of multi-drug therapy for diabetes will follow the same trends observed in our model. We used a recently validated model to tailor prediction of the rate of mild hypoglycemic events in type 2 diabetic adults as a function of disease duration, hemoglobin A1c level, body mass index, kidney function, and class of glucose-lowering medication [ 19 ]. The age-stratified mean values obtained may not be generalizable to individual patients with unique risk profiles.…”

“…Average rates of mild hypoglycemic events per person-year by age group for each medication class were calculated using a validated model that combines measures of average diabetes duration, hemoglobin A1c, body mass index, and glomerular function rate [ 19 ] ( Table 1 ). Average values of hemoglobin A1c, body mass index, and glomerular function rate in diabetic adults aged 65–79 years versus 80 year olds were obtained from the literature [ 20 ].…”

“… Incidence rates for mild hypoglycemic events were calculated from the following equation [ 19 ]: Rate of mild hypoglycemia = Base rate by medication class x Risk Duration x Risk Hemoglobin A1c x Risk Body mass index x Risk Glomerular function rate Risk Duration = 1.037 Min[duration,20.0]-9.0years Risk Hemoglobin A1c = 0.82 (Hemoglobin A1c-7.0%) Risk Body mass index = 0.95 Min[Max[body mass index,21.0]35.0]-33.0 Risk Glomerular function rate = 22700 (Min[60.0,Max[glomerular renal function,15.0]]-0.86655–60.0–0.86655) /1.2 …”

“…Severe hypoglycemic events were predicted to occur at a frequency of 1.25% in the U.S. population [ 19 ]. As no robust estimate of moderate hypoglycemic events could be found, we combined moderate and severe hypoglycemic events into a single category with a predicted frequency of 5% [ 23 ].…”

Incidence and cost of hypoglycemic events requiring medical assistance in a hospital setting in Denmark

“…Each severe HE leading to hospitalization incurs an average cost of €2806.8 [14]. In a US setting, Foos et al estimate the direct cost of an HE requiring assistance from a healthcare practitioner of US$1161 (€1088) per episode [15]; and Samuel et al estimate the yearly cost of mild HE to approximately US$900 million roughly equal to that of severe HE [16].…”