Introduction
Methods
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MEDES (https://www.medes.com/Public/Home.aspx): (((hipoglucem*[título] OR hipoglucem*[resumen] OR hipoglucem*[palabras_clave]) AND ((epidemiologia[título] OR epidemiologia[resumen] OR epidemiologia[palabras_clave]) OR (incidencia[título] OR incidencia[resumen] OR incidencia[palabras_clave]) OR (prevalencia[título] OR prevalencia[resumen] OR prevalencia[palabras_clave]) OR (calidad[título] OR calidad[resumen] OR calidad[palabras_clave]) OR (vida[título] OR vida[resumen] OR vida[palabras_clave]) OR (carga[título] OR carga[resumen] OR carga[palabras_clave]) OR (coste*[título] OR coste*[resumen] OR coste*[palabras_clave]) OR (econom*[título] OR econom*[resumen] OR econom*[palabras_clave])))) AND (2007[año_publicación]: 2017[año_publicación])
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Ovid (http://link.am.lilly.com/sites/link/DataSources/Pages/EMBASE.aspx): Database: Embase <1974–2017 April 17> ; Ovid MEDLINE(R) <1946 to April Week 1 2017>.1.exp *nocturnal hypoglycemia/or exp *hypoglycemia/or exp *insulin hypoglycemia/(41,684)2.Item 1 or hypoglyc*.ti. (51,796)3.(spain OR espagne OR espana OR spain OR espagne OR espana OR osasunbide* OR osakidetza OR insalud OR sergas OR catalunya OR catalonia OR catalogne OR cataluna OR catala OR barcelon* OR tarragona OR lleida OR lerida OR girona OR gerona OR sabadell OR hospitalet OR l’hospitalet OR valencia* OR castello* OR alacant OR alicant* OR murcia* OR andalu* OR sevill* OR granad* OR huelva OR almeria OR cadiz OR jaen OR malaga OR [cORdoba not argentin*] OR extremadura OR caceres OR badajoz OR madrid OR castilla OR salamanca OR zamORa OR valladolid OR segovia OR sORia OR palencia OR avila OR burgos OR [leon not {france OR clermont OR rennes OR lyon OR USA OR mexic*}] OR galicia OR gallego OR compostela OR vigo OR cORuna OR ferrol OR ORense OR ourense OR pontevedra OR oviedo OR gijon OR asturia* OR cantabr* OR santander OR vasco OR euskadi OR basque OR bilbao OR bilbo OR donosti* OR san sebastian OR vizcaya OR biscaia OR guipuzcoa OR gipuzkoa OR alava OR araba OR vitORia OR gazteiz OR navarr* OR nafarrona OR pamplona OR iruna OR irunea OR aragon* OR zaragoza OR teruel OR huesca OR mancha OR ciudad real OR albacete OR cuenca OR [toledo not {ohio OR us OR usa OR OH}] OR (guadalajara not mexic*) OR balear* OR mallORca OR menORca OR ibiza OR eivissa OR palmas OR lanzarote OR canari* OR tenerife).mp. (223,672)4.Items 2 and 3 (140)5.Limit 4 to year = “2007–2017” (103)6.5 not clinical trial/(93)7.Limit 6 to (conference abstract or conference paper or conference proceeding or “conference review” or editorial) [Limit not valid in Ovid MEDLINE(R); records were retained] (18)8.6 not 7 (75)
Results
Description of the Selected Studies in the SLR
Epidemiology of Hypoglycemia
Studies/references | Study design | Period to register hypoglycemia | Study entry criteria (cases) | Healthcare system setting | Number of patients | Mean age (years)a | |
---|---|---|---|---|---|---|---|
According to follow-up | According to data collection | ||||||
T1DM | |||||||
Reviriego et al. [31] | Retrospective | Cross-sectional | 2 years | Patients who experienced at least one SH | Hospital | 100 | 33.22 ± 12.17 |
Carral et al. [32] | Retrospective | Cross-sectional | 1 month | 16 to 60 year-old patients with T1DM (at least 12 months) | Hospital (endocrinologist) | 130 | 33.90 ± 11.50 |
T2DM | |||||||
Durán Alonso et al. [19] | Retrospective | Cross-sectional | NA | Elderly patients with T2DM | PC (nursing homes) | 312 | 79.70 |
Pérez et al. [20] | Retrospective | Cross-sectional | 1 year | ≥ 18 year-old patients with T2DM (at least 12 months) | PC | 5382 | 66.70 ± 10.80 |
Depablos-Velasco et al. [21] | Retrospective | Cross-sectional | 1 year | ≥ 40 year-old patients with T2DM (at least 12 months) | PC | 751 | 67.70 ± 9.90 |
Sicras-Mainar et al. [22] | Retrospective | Longitudinal | 2 year | ≥ 40 year-old patients with T2DM (at least 12 months) | PC and hospital | 3760 | 67.80 ± 11.30 |
Alonso-Morán et al. [23] | Retrospective | Cross-sectional | 1 year | Patients with T2DM or unspecified | Hospital | 134,413 | – |
Jódar-Gimeno et al. [24] | Retrospective | Cross-sectional | 6 months | ≥ 18 year-old patients with DM (at least 12 months), receiving treatment | PC and specialized care | 3812 | 64 ± 11 |
T1DM and T2DM | |||||||
Lindner et al. [25] | Retrospective | Cross-sectional | 1 year | Hospitalizations due to SHE obtained from BMDS | Hospital | 3,254,464 | – |
Orozco-Beltrán et al. [26] | Retrospective | Cross-sectional | 7 previous days (NSHE) and 1 year (SHE) | > 15 year-old patients with DM, receiving insulin | – | 630 | T1DM: 39.90 ± 12.80 T2DM: 63.50 ± 15.10 |
DM | |||||||
Brod et al. [27] | Retrospective | Cross-sectional | 1 month | ≥ 18 year-old patients, with DM, who presented at least one episode of NSNHE the last month | – | 242 | 42.20 ± 11.90 |
Brod et al. [28] | Retrospective | Cross-sectional | 1 month | ≥ 18 year-old patients, with DM, who presented at least one episode of NSNHE the last month | – | 242 | 42.20 ± 11.90 |
Barranco et al. [29] | Retrospective | Cross-sectional | 1 year | All registered emergency calls in Andalusia | Emergency service | 8683 emergency calls for hypoglycemic event | 66 ± 20.20 |
Gómez-Huelgas et al. [30] | Retrospective | Cross-sectional | 14 years | Discharges with diabetes obtained from BMDS | Hospital | 5,447,725 | 70.20 ± 13.90 |
Neonatal | |||||||
García-Patterson et al. [33] | Retrospective | Cross-sectional | 20 years | Pregnancies with GDM with a gestational age > 22 weeks | Hospital | 2029 newborns | Maternal 33 (17–46) |
Studies/references | Mean duration of diabetes (years)a | Hypoglycemia frequency | Total number of hypoglycemic events/year | Nocturnal hypoglycemia | |||
---|---|---|---|---|---|---|---|
SHE | NSHE | SHE | NSHE | ||||
T1DM | |||||||
Reviriego et al. [31] | 16.90 ± 10.90 | Mean: 2.99 events/patient/2 years (1.50 events/patient/yearb) Median: 2/patient/2 years (1/patient/yearb) | – | – | – | ||
Mean: 54.40 events/patient/2 years (27.20 events/patient/yearb) Median: 24/patient/2 years (12/patient/yearb) | |||||||
Carral et al. [32] | 16.50 ± 9.50 | 7.40 events/patient ± 5.80 in the last month | – | – | |||
T2DM | |||||||
Durán Alonso et al. [19] | 66.90% ≥ 10 years 25.40% ≥ 5 years 6.10% ≤ 5 years 1.60% ≤ 1 year | 15.70% (symptomatic) | – | – | |||
Pérez et al. [20] | 8.80 ± 6.30 | 6.80% | 93.20% (NSHE or not hypo) | – | – | ||
Depablos-Velasco et al. [21] | 8.40 ± 6.50 | 1.90% (≥ 1/year) | 9.60% (> 1/month) | – | – | – | |
Sicras-Mainar et al. [22] | 8.50 ± 3.50 | 37.70% (need medical attention) | – | – | |||
Alonso-Morán et al. [23] | – | 0.56% | – | 0.63 episodes/patient | – | – | |
Jódar-Gimeno et al. [24] | 10 ± 7 | 45% | – | ||||
T1DM and T2DM | |||||||
Lindner et al. [25] | – |
–
| – | 0.82% T2DM: 1.82 per 10,000 | – | – | |
Orozco-Beltrán et al. [26] | T1DM: 18.50 ± 11 T2DM: 20 ± 16.40 |
–
| T1DM: 1.70 events/week T2DM: 0.40-0.80 events/week | T1DM: 0.90 events/year T2DM: 0.30-0.40 events/year | T1DM: 88 events/year T2DM: 18.30-42.10 events/year | T1DM NSHE: 26% T2DM NSHE: 30–32% | |
DM | |||||||
Brod et al. [27] | 10.20 ± 8.50 | – | 100% | – | 100% | ||
Brod et al. [28] | 10.20 ± 8.50 | – | 100% | – | 100% (21.60 events/year) | ||
Barranco et al. [29] | – | – | – | General population: 10.34 episodes per 10,000 person/year DM patients: 80 (78-83) episodes per 10,000 person/year | – | No. of patients: 2297 Nocturnal SHEs: 0.34 episodes per hour of all urgencies registered | |
Gómez-Huelgas et al. [30] | – | 1.70% discharges with primary hypoglycemia 2.80% with secondary hypoglycemia | – | – | – | ||
Neonatal | |||||||
García-Patterson et al. [33] | – | 3% | – | – |
Type 1 Diabetes Mellitus
Type 2 Diabetes Mellitus
Nocturnal Hypoglycemia
Resource Utilization and Costs
Studies/references | Type of hypoglycemia | Follow-up period | Number of patients/cases | Healthcare resources utilization/hypoglycemia | Costs related to hypoglycemia | Work impact | |||
---|---|---|---|---|---|---|---|---|---|
Direct costs | Indirect costs | Total costs | |||||||
T1DM | |||||||||
Reviriego et al. [31] | SHE | 2 years | 100 | Cost per SHE: Hospitalization: €204.98 Diagnosis: €12.32 Medication: €5.60 Other: €45.93 | Cost per SHE: €142.26 | Cost per SHE: €409.97 | |||
T2DM | |||||||||
Pérez et al. [20] | SHE/NSHE | 1 year | 5382 | Medical attention: 6.80% Hospitalization: 0.50% Outpatient care: 4.60% Unspecified: 1.70% | |||||
Sicras-Mainar et al. [22] | SHE | 2 years | 3760 | PC: 34.10% Hospitalization: 0.50% ED: 1% | |||||
Alonso-Morán et al. [23] | SHE | 1 year | 134,413 | Annual cost per patient who suffered ≥ 1 HE: | Total healthcare annual cost per patient who suffered ≥ 1 HE, by sex: M: €11,257.50 W: €10,759.52 On average an SHE accounted for additional €2549.88 in annual healthcare costs | ||||
PC: M: €1049.83 W: €1160.61 | |||||||||
Prescriptions: M: €1419.76 W: €1570.18 | |||||||||
Specialized care: M: €1268.34 W: €1513.26 | |||||||||
ED: M: €432.94 W: €439.04 | |||||||||
Hospitalization: M: €7085.61 W: €6076.43 | |||||||||
Jódar-Gimeno et al. [24] | SHE/NSHE | 6 months | 3812 | Hospitalization: 11% (mean: 1.63 visits) ED: 26% (mean: 1.86 visits) | Work absences: 14% of patients | ||||
T1DM and T2DM | |||||||||
Lindner et al. [25] | SHE | 1 year | 3,254,464 hospitalizations due to SHE | Hospitalization: T1DM: 6.34% T2DM: 5.01% | |||||
Orozco-Beltrán et al. [26] | SHE/NSHE | 7 previous days (NSHE) and 1 year (SHE) | 630 | SHE: Hospitalization: 19% ED: 30% NSHE: PC: 8% daytime and 12% nocturnal (T1DM) PC: 20% (T2DM) | Test strips by event: €1.32 | T1DM NSHE: 18% lost work time (mean: 1.50 h/event) T2DM NSHE: 15% lost work time (mean: 1 h/event) | |||
DM | |||||||||
Brod et al. [27] | NSNHE | 1 month | 242 | HCP: 24% | – | ||||
Brod et al. [28] | NSNHE | 1 month | 242 | HCP: 24% | Yearly cost for fall: €686.83 | Cost per NSHE: €357.45 | Annual economic burden of the sample: €32810.65 | 11.80% patients missed a mean of 10.40 h of working time | |
Barranco et al. [29] | SHE | 1 year | 8683 emergency calls for HE | After emergency call: 13.83% events solved over the phone 85% required domiciliary assistance by emergency team After receiving domiciliary assistance: 21% of patients required hospital referral (24.10% M and 19.40% W) | Cost per SHE: Emergency care in place or residence: €471.34 ± 277.32 Transfer to hospital: €30.47 ± 74.15 Emergency hospital care (< 24 h): €211.29 ± 414.45 Cost per nocturnal SHE: Emergency care in place or residence: €481.50 ± 255.99 Transfer to hospital: €24.38 ± 69.08 Emergency hospital care (< 24 h): €172.69 ± 383.98 Cost per SHE requiring emergency hospital care: Emergency care in place or residence: €532.29 ± 315.92 Transfer to hospital: €145.26 ± 99.55 Emergency hospital care (< 24 h): €1025.98 ± 0 Cost per SHE causing loss of consciousness: Emergency care in place or residence: €656.22 ± 268.18 Transfer to hospital: €38.60 ± 76.19 Emergency hospital care (< 24 h): €333.19 ± 480.48 | Cost per SHE, by type: SHE: €713.10 ± 573.94 Nocturnal: €678.57 ± 11.17 Requiring emergency care: €1703.53 ± 308.81 Loss of consciousness: €1028.01 ± 610.51 | |||
Gómez-Huelgas et al. [30] | SHE/NSHE | 14 years | 5,447,725 discharges with a diagnosis of diabetes obtained from BMDS (1.70% primary hypoglycemia and 2.80% secondary hypoglycemia) | Mean of stay in hospital: Primary hypoglycemia: 9.01 (11.72) days Secondary hypoglycemia: 12.04 (13.40) days |
Severe Hypoglycemia
Severe and Non-Severe Hypoglycemia
Impact at Work
Quality of Life
Studies/references | Type of diabetes | Number of patients | Health-related QoL questionnaires | ||||||||
---|---|---|---|---|---|---|---|---|---|---|---|
ADDQoLa | DTSQb | HFS-IIc | |||||||||
Control population | Hypo population | p value | Control population | Hypo population | p value | Control population | Hypo population | p value | |||
Depablos-Velasco et al. [21] | T2DM | 751 | < 1 SHE: − 1.80 (1.90) | ≥ 1 SHE: − 2.80 (2.10) | 0.049 | < 1 SHE: 29.30 (6.00) | ≥ 1 SHE: 26.90 (7.10) | 0.157 | < 1 SHE: 10.90 (14.40) | ≥ 1 SHE: 24.10 (22.10) | 0.003 |
≤ 1 NSHE/month: − 1.80 (1.90) | > 1 NSHE/month: − 2.00 (1.80) | 0.405 | ≤ 1 NSHE/month: 29.40 (6.10) | > 1 NSHE/month: 28.50 (5.30) | 0.238 | ≤ 1 NSHE/month: 10.60 (14.50) | > 1 NSHE/month: 16.90 (14.50) | 0.001 | |||
Jódar-Gimeno et al. [24] | T2DM | 3812 | Patients without hypoglycemia: − 1.64 (1.36) | Patients with hypoglycemia: − 2.48 (1.61) | < 0.001 | – | – | – | Patients without hypoglycemia: 18.85 (16.03) | Patients with hypoglycemia:31.32 (15.71) | < 0.001 |