Excerpt

Prevalence of type 2 diabetes is increasing at an alarming pace, fueled by the rising rates of overweight and obesity in many populations. In the VA healthcare system, the prevalence of diabetes was 20% in fiscal year 2000 and is now estimated at nearly 25%.

Although people with diabetes have a substantially increased risk of cardiovascular disease (CVD), recent trials show that intensive glucose lowering does not reduce the risk of CVD death or all-cause mortality although it reduces the risk of microvascular complications (nephropathy, retinopathy and neuropathy) and possibly non-fatal myocardial infarction. Intensive glucose control also increases the risk of hypoglycemic episodes. Several recent meta-analyses of the trials comparing intensive to conventional glucose control concluded that intensive control is associated with a 2–2.5 fold increased risk of severe hypoglycemia. The reviews however have not included smaller randomized trials, trials focused on the comparison of specific drug regimens, and non-randomized trials. We conducted the current review to provide broader insight into the incidence of, the risk factors for, and the clinical and social impact of severe hypoglycemia in adults with type 2 diabetes treated with glucose lowering medications.

Contents

• PREFACE
• EXECUTIVE SUMMARY
  • BACKGROUND
  • METHODS
  • DATA SYNTHESIS
  • PEER REVIEW
  • RESULTS
  • FUTURE RESEARCH RECOMMENDATIONS
• INTRODUCTION
• METHODS
  • TOPIC DEVELOPMENT
  • SEARCH STRATEGY
  • STUDY SELECTION
  • DATA ABSTRACTION
  • QUALITY ASSESSMENT
  • DATA SYNTHESIS
  • PEER REVIEW
• RESULTS
  • LITERATURE FLOW
  • KEY QUESTION #1 What is the incidence of severe hypoglycemia in adults with type 2 diabetes on one or more hypoglycemic agents?
  • KEY QUESTION #2 What are the risk factors for severe hypoglycemia in adults with type 2 diabetes on one or more hypoglycemic agents (e.g., demographics, co-morbidities, diabetes treatment regimen, other medication use, goal and achieved HbA1c)?
  • KEY QUESTION #3 What is the effect of severe hypoglycemia on other outcomes in adults with type 2 diabetes on one or more hypoglycemic agents (e.g., quality of life, mortality, morbidity, utilization)?
• SUMMARY AND DISCUSSION
  • SUMMARY OF EVIDENCE BY KEY QUESTION
  • RECOMMENDATIONS FOR FUTURE RESEARCH
• REFERENCES
• APPENDIX A SEARCH STRATEGY
• APPENDIX B CRITERIA USED IN QUALITY ASSESSMENT OF NON-RANDOMIZED STUDIES
• APPENDIX C PEER REVIEW COMMENTS/AUTHOR RESPONSES
• APPENDIX D STUDY QUALITY TABLES
• APPENDIX E EVIDENCE TABLES
• APPENDIX F FOREST PLOTS FOR KEY QUESTION #1

Prepared for: Department of Veterans Affairs, Veterans Health Administration, Quality Enhancement Research Initiative, Health Services Research & Development Service, Washington, DC 20420. Prepared by: Evidence-based Synthesis Program (ESP) Center, Minneapolis VA Medical Center, Minneapolis, MN, Timothy J. Wilt, M.D., M.P.H., Director.

Suggested citation:

Bloomfield HE, Greer N, Newman D, MacDonald R, Carlyle M, Fitzgerald P, Rutks I, and Wilt, TJ. Predictors and Consequences of Severe Hypoglycemia in Adults with Diabetes – A Systematic Review of the Evidence. VA-ESP Project #09-009; 2012.

This report is based on research conducted by the Evidence-based Synthesis Program (ESP) Center located at the Minneapolis VA Medical Center, Minneapolis, MN funded by the Department of Veterans Affairs, Veterans Health Administration, Office of Research and Development, Quality Enhancement Research Initiative. The findings and conclusions in this document are those of the author(s) who are responsible for its contents; the findings and conclusions do not necessarily represent the views of the Department of Veterans Affairs or the United States government. Therefore, no statement in this article should be construed as an official position of the Department of Veterans Affairs. No investigators have any affiliations or financial involvement (e.g., employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties) that conflict with material presented in the report.