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If your members experience hypoglycemia, you may only be seeing the tip of the iceberg

Suboptimal control

Suboptimal control1-4

Many patients self-modify their insulin dose to reduce the risk of hypoglycemic events, which may result in suboptimal glycemic control.1

Suboptimal glycemic control can lead to an increased risk of long-term complications.1-4

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Severe hypoglycemia can require significant resources from the viewpoint of ambulance use, ER visits, and hospital admission.5

In one study, 157 (29.3%) of 536 severe hypoglycemic events required an ambulance/emergency team.5

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Severe hypoglycemia may require assistance from health care professionals.5

In an analysis of data from combined studies, 536 severe hypoglycemic events were analyzed. Of these, 64 (11.9%) led to a hospital/ER visit ≤24 hours, and 36 (6.7%) required hospital admission >24 hours.5

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ER visits

ER visits6

Severe hypoglycemia is costly to manage and can require glucagon injection treatment, ER visits, and even hospitalization.6

The cost of managing a hypoglycemic episode that requires hospitalization, ER visits, or glucagon injections ranges from $176 to $16,478 (event-year costs).6

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Cognitive dysfunction

Falls and fractures

Falls and fractures7

Patients with hypoglycemic events had 70% higher regression-adjusted odds of fall-related fractures than patients without hypoglycemic events.7

The average cost for hospitalized falls (not necessarily related to hypoglycemia) was $26,483 for adults aged ≥60 years.8

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Hypoglycemia was associated with a 92% and 50% significantly increased risk, respectively, of composite CVEs in T1D and T2D cohorts.9

CVEs are expensive to manage and lead to high costs in the first year and subsequent years. For a nonfatal MI, estimates of the event-year direct cost ranged from $8,792 to $53,568. For nonfatal stroke, the event-year direct cost estimates ranged from $3,332 to $79,074.10

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Hypoglycemia places significant clinical and cost burdens on the health care system, with the full impact still hidden beneath the surface

Study design information


  1. Leiter LA, Yale J-F, Chiasson J-L, Harris S, Kleinstiver P, Sauriol L. Assessment of the impact of fear of hypoglycemic episodes on glycemic and hypoglycemia management. Can J Diabetes. 2005;29(3):186-192.
  2. UK Prospective Diabetes Study (UKPDS) Group. Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). Lancet. 1998;352(9131):837-853.
  3. American Diabetes Association. Standards of medical care in diabetes—2018. Diabetes Care. 2018;41(suppl 1):S1-S159.
  4. The Diabetes Control and Complications Trial Research Group. The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. N Engl J Med. 1993;329(14):977-986.
  5. Heller SR, Frier BM, Hersløv ML, Gundgaard J, Gough SC. Severe hypoglycaemia in adults with insulin-treated diabetes: impact on healthcare resources. Diabet Med. 2016;33(4):471-477.
  6. Ward A, Alvarez P, Vo L, Martin S. Direct medical costs of complications of diabetes in the United States: estimates for event-year and annual state costs (USD 2012). J Med Econ. 2014;17(3):176-183.
  7. Johnston SS, Conner C, Aagren M, Ruiz K, Bouchard J. Association between hypoglycaemic events and fall-related fractures in Medicare-covered patients with type 2 diabetes. Diabetes Obes Metab. 2012;14(7):634-643.
  8. Davis JC, Robertson MC, Ashe MC, Liu-Ambrose T, Khan KM, Marra CA. International comparison of cost of falls in older adults living in the community: a systematic review. Osteoporos Int. 2010;21(8):1295-1306.
  9. Khunti K, Davies M, Majeed A, Thorsted BL, Wolden ML, Paul SK. Hypoglycemia and risk of cardiovascular disease and all-cause mortality in insulin-treated people with type 1 and type 2 diabetes: a cohort study. Diabetes Care. 2015;38(2):316-322.
  10. Brennan VK, Colosia AD, Copley-Merriman C, Mauskopf J, Hass B, Palencia R. Incremental costs associated with myocardial infarction and stroke in patients with type 2 diabetes mellitus: an overview for economic modeling. J Med Econ. 2014;17(7):469-480.