Management of severe hypoglycaemia: cultural similarities, differences and resource consumption in three European countries

J Med Econ. 2009;12(4):269-80. doi: 10.3111/13696990903310501.


Background: To investigate the characteristics of people with insulin-treated diabetes, who have experienced severe hypoglycaemic events (SHEs), in Germany, Spain or UK.

Methods: Patients with type 1 (n=319) or insulin-treated type 2 diabetes (n=320) who had experienced ≥ 1 SHE in the preceding year were enrolled. Their median age was 53 years (range, 16-94 years). Data were collected using a questionnaire administered by an experienced interviewer.

Results: The median number of reported SHEs was 2-3 in 12 months. Most events (69%) occurred at home, usually during the day or evening (74%) and most commonly due to insufficient food consumption (45%). In patients whose hypoglycaemia awareness was tested, 68% had normal awareness. Patients requiring emergency healthcare treatment frequently had impaired hypoglycaemia awareness, and developed hypoglycaemic coma more often. Hospital treatment was usually provided in an emergency department (72-94%). The duration of stay was longest in Germany. Following a SHE, patients receiving professional treatment were more likely to: consult their physician, test their blood glucose more often, adjust insulin dose and receive self-management training.

Conclusions: This survey of diabetes patients aged 16-94 years showed that SHEs represent a substantial burden on national healthcare systems in Germany, UK and Spain. The pattern of occurrence and treatment was similar in all three countries, despite differences in cultures and healthcare systems.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Cross-Cultural Comparison
  • Diabetes Mellitus, Type 1 / blood*
  • Diabetes Mellitus, Type 1 / drug therapy
  • Diabetes Mellitus, Type 1 / epidemiology
  • Diabetes Mellitus, Type 2 / blood*
  • Diabetes Mellitus, Type 2 / drug therapy
  • Diabetes Mellitus, Type 2 / epidemiology
  • Energy Intake / physiology
  • Female
  • Germany / epidemiology
  • Health Services / statistics & numerical data
  • Humans
  • Hypoglycemia / epidemiology
  • Hypoglycemia / therapy*
  • Hypoglycemic Agents / administration & dosage
  • Hypoglycemic Agents / adverse effects
  • Hypoglycemic Agents / therapeutic use
  • Insulin / administration & dosage*
  • Insulin / adverse effects
  • Male
  • Middle Aged
  • Retrospective Studies
  • Spain / epidemiology
  • United Kingdom / epidemiology
  • Young Adult


  • Hypoglycemic Agents
  • Insulin