Healthcare resource use, direct and indirect costs of hypoglycemia in type 1 and type 2 diabetes, and nationwide projections. Results of the HYPOS-1 study

Nutr Metab Cardiovasc Dis. 2017 Mar;27(3):209-216. doi: 10.1016/j.numecd.2016.10.005. Epub 2016 Nov 18.


Background and aims: To obtain an accurate picture of the total costs of hypoglycemia, including the indirect costs and comparing the differences between type 1 (T1DM) and type 2 diabetes mellitus (T2DM).

Methods and results: HYPOS-1 was a multicenter, retrospective cohort study which analyzed the data of 2229 consecutive patients seen at 18 diabetes clinics. Data on healthcare resource use and indirect costs by diabetes type were collected via a questionnaire. The domains of inpatient admission and hospital stay, work days lost, and third-party assistance were also explored. Resource utilization was reported as estimated incidence rates (IRs) of hypoglycemic episodes per 100 person-years and estimated costs as IRs per person-years. For every 100 patients with T1DM, 9 emergency room (ER) visits and 6 emergency medical service calls for hypoglycemia were required per year; for every 100 patients with T2DM, 3 ER visits and 1 inpatient admission were required, with over 3 nights spent in hospital. Hypoglycemia led to 58 work days per 100 person-years lost by the patient or a family member in T1DM versus 19 in T2DM. The costs in T1DM totaled €90.99 per person-year and €62.04 in T2DM. Direct and indirect costs making up the total differed by type of diabetes (60% indirect costs in T1DM versus 43% in T2DM). The total cost associated with hypoglycemia in Italy is estimated to be €107 million per year.

Conclusions: Indirect costs meaningfully contribute to the total costs associated with hypoglycemia. As compared with T1DM, T2DM requires fewer ER visits and incurs lower indirect costs but more frequent hospital use.

Keywords: Diabetes mellitus; Direct and indirect costs; Hypoglycemia.

Publication types

  • Comparative Study
  • Multicenter Study

MeSH terms

  • Absenteeism
  • Cost Savings
  • Cost-Benefit Analysis
  • Diabetes Mellitus, Type 1 / diagnosis
  • Diabetes Mellitus, Type 1 / drug therapy*
  • Diabetes Mellitus, Type 1 / economics*
  • Diabetes Mellitus, Type 2 / diagnosis
  • Diabetes Mellitus, Type 2 / drug therapy*
  • Diabetes Mellitus, Type 2 / economics*
  • Emergency Service, Hospital / economics
  • Forecasting
  • Health Care Costs* / trends
  • Health Expenditures
  • Health Resources / economics*
  • Health Resources / statistics & numerical data
  • Health Resources / trends
  • Hospital Costs
  • Hospitalization / economics
  • Humans
  • Hypoglycemia / chemically induced
  • Hypoglycemia / diagnosis
  • Hypoglycemia / economics*
  • Hypoglycemia / therapy*
  • Hypoglycemic Agents / adverse effects*
  • Italy
  • Length of Stay / economics
  • Models, Economic
  • Retrospective Studies
  • Sick Leave / economics


  • Hypoglycemic Agents