Trends and Disparities in Severe Hypoglycemia among Adult Diabetic patients in Taiwan from 1999 to 2007: A Population-based Study

Background: Although hypoglycemia is one most common complication of intensive diabetes therapy, there is little information about risk factors for hypoglycemia in diabetic patients, particularly in Asian populations. This objective of this study was to describe changes in severe hypoglycemia (SH) requiring emergency department (ED) visits or hospitalizations among diabetic patients in Taiwan from 1999 to 2007, and identify its risk factors. Methods: A nationally representative sample of 1,000,000 National Health Insurance enrollees were observed from 1999 to 2007. Of this sample, only those medication-using diabetic patients aged 20 or older were included and a total of 258,522 person-year were finally analyzed. Outcome events were defined as 1 or more ED visits or hospitalizations for hypoglycemia. Logistic regressions and General Estimating Equations were applied. Results: From 1999 to 2007, the prevalence of medication-using diabetic patients increased from 3.13% to 5.25%. More importantly, the hospitalization rate increased substantially from 9.5‰ to 13.3‰ during the study period. Male patients (OR 1.19; 95%CI, 1.12 to 1.26) and those who lived in north region (OR 1.36; 95%CI, 1.16 to 1.60) were at a significantly higher risk of SH. A U-shape was observed for the relationship between age and risk of SH. Moreover, those with a higher socioeconomic status were significantly more like to have an event. Conclusions: In this population-based study of adult diabetic patients, male patients, younger age and higher socioeconomic status were risk factors of an emergency visit or hospitalization for severe hypoglycemia.