Changes in Management of Type 2 Diabetes Before and After Severe Hypoglycemia
Pavithra Vijayakumar, Shuling Liu, Rozalina G. McCoy, Andrew J. Karter, Kasia J. Lipska
Abstract
Severe hypoglycemia in patients with diabetes is an adverse drug event that is associated with poor outcomes, such as cardiovascular events, falls, high rehospitalization rates, and increased mortality (1,2). Several strategies, including adjustment of glucose-lowering therapy and glycemic targets, have been recommended in patients with severe hypoglycemia (1,3). However, it is not clear how changes in diabetes management are maintained after severe hypoglycemia among patients with type 2 diabetes. We conducted a retrospective analysis of data from the OptumLabs Data Warehouse, a de-identified administrative claims database of over 200 million individuals enrolled in commercial and Medicare Advantage plans across the U.S. (4). Data were accessed in adherence with the Health Insurance Portability and Accountability Act of 1996, and the Yale School of Medicine Human Investigations Committee deemed the study exempt from institutional review board review. We included commercially insured or Medicare Advantage beneficiaries who were aged 18 years or older, had pharmacologically treated type 2 diabetes, and had a severe hypoglycemic event. Severe hypoglycemia was identified as the first event during an observation window of 1 July 2013 through 30 June 2014, based on primary/principal diagnosis codes for hypoglycemia from an emergency department visit, observation stay, or hospital …