Progress of diabetes severity associated with severe hypoglycemia in Taiwan

OBJECTIVES: The association between the progression of diabetes severity and risk of severe hypoglycemia is unknown. This study aimed to evaluate the association between the progression of diabetes severity and severe hypoglycemia in patients with diabetes. STUDY DESIGN: A 13-year population-based retrospective cohort study of patients with diabetes in Taiwan. METHODS: Diabetes progression was evaluated by the adapted Diabetes Complications Severity Index (aDCSI) score from index date to end of follow-up. The progression of diabetes severity was divided into 3 categories: slow, moderate, and rapid increase in aDSCI score. We further compared those 3 categories and evaluated the risk of first hospitalization due to severe hypoglycemia. RESULTS: A total of 330,831 patients with diabetes were recruited. The mean age of patients in this study was 56.8 years, and mean follow-up duration was 9.3 years. The mean initial aDCSI score was 0.7, whereas the mean aDCSI score at the event date or end date was 2.9. A rapid increase in aDCSI score was associated with higher risk of severe hypoglycemia compared with a slow increase (hazard ratio, 4.91; 95% CI, 4.65-5.18). The incidence densities of severe hypoglycemia (per 1000 person-years) for slow, moderate, and rapid increase in aDCSI score were 2.3, 2.5, and 11.4, respectively. CONCLUSIONS: This study demonstrated that rapid progression of diabetes complications was associated with higher risk of severe hypoglycemia. It is imperative that treating physicians identify patients with acute worsening of diabetes severity and provide proper hypoglycemia education and prevention care.