What can drug therapy tell us about severe hypoglycemic events?

October 1, 2018

Also known as “insulin shock,” hypoglycemia (HG) occurs when blood sugar reaches dangerously low levels. This can trigger serious symptoms, such as impaired vision, seizures and unconsciousness.1 Despite the association of diabetes with high blood sugar, low blood sugar is also common — and just as serious.

Helping people get the medicine they need to feel better and live well means doing everything we can to optimize outcomes. This includes understanding how medicine and health events, such as emergency department visits, may be related.  Not only can this knowledge help us understand and encourage medicine use that improves health outcomes for members — it can help plan sponsors lower the total cost of care.

What we studied
To better understand if and how emergency department visits for HG are related to diabetes types and drug regimens, our team studied data from nearly 4 million members. Within this population, we looked at more than 4,100 emergency department visits that were coded for HG (indicating a severe health event).

What we learned
Our research found that:

  • Emergency department visits for HG occurred at a rate of about 15 per 1,000 patient years (events divided by time receiving medicine) among members treated with insulin.
  • Members with Type 1 diabetes had nearly 250 percent more emergency department visits than members with Type 2 diabetes.
  • Members with Type 2 diabetes were three times more likely to have an emergency department visit for HG if they were using both long- and short-acting insulin (basal/bolus therapy) versus the more common therapy of only long-acting insulin.

What plan sponsors can do
The diabetes drug landscape is changing. Lantus®, the most commonly used long-acting insulin recently lost its U.S. patent, opening the market for generic competition. Two new drugs “ultra-long-acting” insulin drugs (Toujeo® and Tresiba®) were approved and offer potential to lower the risk for severe hypoglycemic events — but this benefit is expected to come at a premium. Plan sponsors can use this study to help compare how new and existing insulin drugs may impact health outcomes and the total cost of care.


  1. Hypoglycemia (low blood glucose). American Diabetes Association. (2015.) http://www.diabetes.org/living-with-diabetes/treatment-and-care/blood-glucose-control/hypoglycemia-low-blood.html?referrer=https://www.google.com/
Incidence Rate of Emergency Department Visits for Hypoglycemia by Diabetes Drug Regimen in a Four Million Member Commercially Insured Population (Spring 2016)

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