In Endocrinology

A team led by Kaiser Permanente researchers has developed and validated a practical tool for identifying diabetes patients who are at the highest risk for being admitted to an emergency department or hospital due to severe hypoglycemia, or very low blood sugar.

Their results are published in JAMA Internal Medicine.

‘Sometimes a person with diabetes is unaware that their blood sugar is dropping and can progress quickly into severe hypoglycemia, which has been associated with falls, automobile accidents, heart attacks, coma, and even death,’ said Andrew J Karter, PhD, senior research scientist with the Kaiser Permanente Division of Research and the study’s lead author.

‘Hypoglycemia is often preventable with the proper clinical attention, and we believe this tool will help focus that attention on the patients who most need it.’

The researchers developed the hypoglycemia risk stratification tool by identifying 156 possible risk factors for hypoglycemia and collecting data from more than 200,000 patients with type 2 diabetes receiving care from Kaiser Permanente in Northern California.

Using machine-learning analytical techniques, they developed a model to predict a patient’s 12-month risk of hypoglycemia-related emergency department or hospital use.

The final model was based on six variables: number of prior episodes of hypoglycemia-related emergency department visits or hospitalisations; use of insulin; use of sulfonylurea (an oral medication commonly used to treat diabetes); severe or end-stage kidney disease; number of emergency room visits for any reason in the past year; and age.

Based on the model, the researchers created a practical tool to categorise patients into high (greater than five per cent), intermediate (one to five per cent), or low (less than one per cent) annual risk of hypoglycemia-related emergency department or hospital utilisation. The tool was then validated with data from more than 1.3 million members of the US Veterans Health Administration and nearly 15,000 Kaiser

Permanente members in Washington state with type 2 diabetes.
The US Food and Drug Administration (FDA) funded the development of the tool for identifying patients at risk of hypoglycemia under their Safe Use Initiative, a collaborative effort to reduce adverse events related to medication use, including diabetes medications linked to an increased risk of hypoglycemia. The results are being disseminated with help from the Centres for Medicare and Medicaid Services (CMS).

Several public and private healthcare systems and organisations – including CMS, the Mayo Clinic, and Kaiser Permanente – are now examining how they can use the tool to increase awareness about hypoglycemia and bring attention and resources to help patients with type 2 diabetes avoid dangerous episodes in the future.

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