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Challenges exist in directly capturing hypoglycemic events and costs

As a result, the true and overall impact of hypoglycemia on the total cost of care is underestimated

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Not coded as a hypoglycemic event

Identification of hypoglycemic events from clinical notes in the EHR relative to measures from structured data, such as diagnostic codes (ICD-10-CM), increased capture of nonserious events more than 20-fold. This demonstrates the need to better document hypoglycemic events.1

There are many costly events associated with hypoglycemia2

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  • Fractures, joint dislocations, head injuries
  • Soft-tissue injuries
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  • Arrhythmias
  • Myocardial ischemia/infarction
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  • Cognitive impairment
  • Convulsions, coma
  • Paralysis, transient ischemic events, focal lesions

Identifying patients with diabetes at high risk of hypoglycemic events may lead to cost savings


per episode requiring glucagon injection3,a


per episode requiring ER visit3,a


per episode requiring hospitalization3,a

Almost 40% of severe hypoglycemic episodes require hospitalization or outpatient care4

Fall-related fractures are a major cause of morbidity and costs in the elderly population

  • The average cost per injurious fall was $10,749 for adults aged 65 to 74 years5
  • The average cost for hospitalized falls was $26,483 for adults aged ≥65 years5
  • Fractures are the most common nonfatal outcome of falls, and falls are the most common cause of fractures6,7

In this study, falls and fractures were not necessarily related to hypoglycemia.

There are significant costs associated with managing CVEs8

Cost of acute CVE in the first year8,b

to $53,568 for a nonfatal MI

$3332 to $79,074 for a nonfatal stroke

Annual cost of CVE in subsequent years8,b

to $2461 for MI patients 

$3044 to $31,176 for stroke patients

aCosts were analyzed in 2012 US dollars from a comprehensive payer perspective using all insurance channels (commercial, Medicare, Medicaid). Costs shown are event-year costs.
bConverted from British pounds (GBP) in 2012. 1 GBP=US $1.58. 

CVE=cardiovascular event; EHR=electronic health records; ER=emergency room; HCP=health care professional; ICD-10-CM=International Classification of Diseases, Tenth Revision, Clinical Modification; MI=myocardial infarction


  1. Nunes AP, Yang J, Radican L, et al. Assessing occurrence of hypoglycemia and its severity from electronic health records of patients with type 2 diabetes mellitus. Diabetes Res Clin Pract. 2016;121:192-203.
  2. Frier BM. The economic costs of hypoglycaemia. Br J Diabetes Vasc Dis. 2011;11(suppl 1):S10-S12.
  3. 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.
  4. 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.
  5. 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.
  6. Stevens JA, Corso PS, Finkelstein EA, Miller TR. The costs of fatal and non-fatal falls among older adults. Inj Prev. 2006;12(5):290-295.
  7. Bell AJ, Talbot-Stern JK, Hennessy A. Characteristics and outcomes of older patients presenting to the emergency department after a fall: a retrospective analysis. Med J Aust. 2000;173(4):179-182.
  8. 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.