The burden of hypoglycemia on healthcare utilization, costs, and quality of life among type 2 diabetes mellitus patients

J Diabetes Complications. Sep-Oct 2012;26(5):399-406. doi: 10.1016/j.jdiacomp.2012.05.002. Epub 2012 Jun 12.


Objective: To assess the burden of hypoglycemia among type 2 diabetes patients on antidiabetic drugs with or without use of insulin.

Research design and methods: We used mail surveys, administrative claims data, and enrollment information from a sample of adult commercial health plan enrollees (n=813) with type 2 diabetes during a 12-month period. Patients' experience of hypoglycemia, its impact on patient perspectives and healthcare utilization were the outcomes evaluated.

Results: A greater percentage of patients in the antidiabetic with insulin cohort reported experiencing hypoglycemia compared with patients from sulfonylurea (SU) without insulin and non-SU without insulin cohorts (50% vs. 21% and 12%, respectively; p<0.01 for both comparisons). While 71% of the sample reported experiencing hypoglycemic symptoms with 28% confirmed by low blood glucose levels, only 10% of the patients had evidence of hypoglycemia event in the claims database. Patients with confirmed hypoglycemia had the highest Hypoglycemia Fear Survey behavior score (8) and worry subscale score (14). Significant differences were noted between the confirmed hypoglycemia and no hypoglycemia cohorts for the 12-item Short Form Health Survey's Mental Component Score (p<0.001) and Physical Component Score (p=0.002), and for the EQ-5D index (p<0.001). Diabetes-related annualized mean total healthcare costs were significantly higher for confirmed hypoglycemia vs. no hypoglycemia cohorts (p=0.004).

Conclusions: Symptomatic hypoglycemia is a more significant burden among type 2 diabetes patients treated with antidiabetic drugs than is estimated by administrative claims data and needs to be considered when choosing therapy.

Publication types

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

MeSH terms

  • Adult
  • Aged
  • Cohort Studies
  • Cost of Illness*
  • Cross-Sectional Studies
  • Diabetes Mellitus, Type 2 / drug therapy*
  • Drug Therapy, Combination / adverse effects
  • Female
  • Health Care Costs
  • Health Care Surveys
  • Health Resources / statistics & numerical data
  • Humans
  • Hypoglycemia / chemically induced*
  • Hypoglycemia / economics
  • Hypoglycemia / therapy
  • Hypoglycemic Agents / adverse effects*
  • Hypoglycemic Agents / therapeutic use
  • Insulin / adverse effects*
  • Insulin / therapeutic use
  • Insurance, Health
  • Male
  • Middle Aged
  • Quality of Life
  • Retrospective Studies
  • Sulfonylurea Compounds / adverse effects*
  • Sulfonylurea Compounds / therapeutic use
  • United States


  • Hypoglycemic Agents
  • Insulin
  • Sulfonylurea Compounds