Frequency of severe hypoglycaemia
Severe hypoglycaemia (low blood sugar) can lead to impaired consciousness and hypoglycaemic coma and is associated with an increased risk of complications such as cardiovascular events, dementia, fall-related fractures and even death (Amiel 2021). Prevention of particularly severe hypoglycaemic episodes can be seen as a quality indicator of good glycaemic control (Rodriguez-Gutierrez et al. 2016).
Key messages
- Overall, 2.5% of adults with known diabetes were affected by severe hypoglycaemia in the last 12 months.
- No significant sex-, age- or education-related differences were observed.
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By state
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By gender
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By age
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By education group
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Results
In 2014, the proportion of adults with known diabetes who experienced severe hypoglycaemia in the last 12 months and required subsequent medical treatment was 2.5% (women: 2.1%; men: 3.0%). The corresponding proportion varies between age and education groups as well as between eastern and western Germany - however, these differences are not statistically significant, possibly due to the limited number of cases.
Conclusion
Severe hypoglycaemia is a not rare and distressing acute complication in persons with diabetes that can occur due to therapy with antihyperglycemic medications (Alwafi et al. 2020). Minimizing the burden of hypoglycaemia must be therefore an important aim in diabetes therapy. Individualized therapy goals based on a comprehensive consideration of patient characteristics and treatment options can contribute to reaching this aim, as recommended, for example, in the updated Practice Guideline for the therapy of type 2 diabetes (Landgraf et al. 2020).
Show more information on methodology and data sources
Definition
The indicator Frequency of severe hypoglycaemia is defined as the proportion of people with known diabetes who have had severe hypoglycaemia that led to medical treatment within the past 12 months.
Operationalisation
Information provided by the respondents to the following questions:
‘Have you had any of the following illnesses or complaints in the past 12 months’: diabetes (not including gestational diabetes)
If yes, then ‘Have you had acute hypoglycaemia in the past 12 months?’
If yes, then ‘Has this hypoglycaemia led to medical treatment in the past 12 months, such as hospital admission or emergency medical treatment or care?’
Reference population
Resident population in Germany with known diabetes, aged 18 and over
Data source
Nationwide RKI interview survey GEDA 2014/15-EHIS based on a sample from registration offices and self-completion questionnaire (online/written).
Number of cases
- GEDA 2014/15-EHIS: n = 24,016
For the Frequency of severe hypoglycaemia indicator, only people with known diabetes in the past 12 months were considered:
- GEDA 2014/15-EHIS: n = 1,712 people with known diabetes
Calculation
- Description: For the indicator, the figures for total, women and men are provided and are stratified by age group, residential area and education as far as the number of cases available for the figure is ≥ 5 and the statistical uncertainty in the estimate of the indicator is not considered too large (a coefficient variation ≤ 33.5%).
- Stratification: The geographical classification of the residence of the participating person was carried out by east and west (east = former East Germany, including all of Berlin; west = former West Germany, not including West Berlin). Educational status was determined using the CASMIN index, which takes information on both school and vocational training into account and allows a categorisation into a low, medium and high education group.
- Weighting: In order to correct for deviations from the underlying reference population due to different participation rates or sampling probabilities, a weighting factor was used when calculating the indicator. This adjusts the survey to the structure of the resident population in Germany of the reference population in terms of sex, age, federal state, municipality type and education as of 31 December 2014.
Data quality
RKI interview surveys provide representative results for the resident population of Germany aged 18 years and over. As is the case in all population-based studies, underrepresentation of the seriously ill and those living in institutions must be assumed. Furthermore, all information is self-reported and not based on personal interviews conducted by study physicians or standardized measurements or examinations.
