The Monthly Cycle of Hypoglycemia

Abstract

Background Multi-payer initiatives have sought to address social determinants of health, such as food insecurity, by linking primary care patients to social services. It remains unclear whether such social determinants contribute to avoidable short-term healthcare costs. Objectives We sought to quantify costs and mitigating factors for the increased risk of hypoglycemia at the end of each month among low-income Americans, a phenomenon related to exhaustion of food budgets. Research design We used claims data on 595,770 commercially-insured American adults aged 19 through 64 years old from 2004 through 2015 to estimate the risks and costs of emergency room visits and inpatient hospitalizations for hypoglycemia during the last week of each month versus prior weeks. Results While persons with household incomes greater than the national median did not experience a monthly cycle of hypoglycemia, those with incomes less than the national median had an odds ratio of 1.07 (95% CI: 1.02, 1.12; p = 0.005) for emergency room visits or inpatient hospitalizations for hypoglycemia during the last week of each month, compared with earlier weeks. The risk of end-of-the-month hypoglycemia was mitigated to statistical insignificance during a period of increased federal nutrition program benefits from 2009 through 2013. Eliminating the monthly cycle of hypoglycemia among commercially-insured nonelderly adults would be expected to avert $54.1 million per year (95% CI: $0.8, $204.0) in emergency department and inpatient hospitalization costs. Conclusions Addressing the end-of-the-month increase in hypoglycemia risk among lower-income populations may avert substantial costs from emergency department visits and inpatient hospitalizations.

The association between hypoglycemia and hospital use, food insufficiency, and unstable housing conditions: a cross-sectional study among patients with type 2 diabetes in Sudan

“…Another study [17] concluded the association of poor glycemic control and severe hypoglycemia in contradiction to the present findings. Previous researches [22, 27] observed higher severe hypoglycemia among patients with foods insecurity especially among patients with household income below the national income, furthermore, the highest rate of hospital admission with hypoglycemia was commoner during the last week of the month due to exhaustion of food budget. In the current study, no relation between food insufficiency and hypoglycemia risk, a plausible explanation may be the difference in income and other socio-demographic characteristics or the small size of the present sample.…”

Ability to Reach Low-Income Smokers Enrolled in a Randomised Controlled Trial Varies with Time of Month

“…A study evaluating hospital admissions found a 27% increase in admissions for hypoglycaemia for low-income diabetics in the last calendar week of the month compared to the first week (Seligman et al, 2014). A more recent study, found increased odds of ED visit or hospital admission for hypoglycaemia in patients with household incomes less than the national median during Week 4 compared to earlier weeks (Basu, Berkowitz, & Seligman, 2017). Overall, studies show that low-income households struggle with paying for basic needs towards the end of the month, including food, which would be a heavily competing priority for households who purchase cell phone minutes only when they can afford them.…”

Prevalence of Emergency Department Social Risk and Social Needs

“…One study illustrating the former concept demonstrated that low-income individuals were more likely to report to the ED for hypoglycemia at the end of the month, as opposed to the beginning of the month. 23 …”