US scientists have developed a predictive model of long-term risk for severe hypoglycemia in people with type 2 diabetes.
People with type 2 diabetes who take glucose-lowering medication such as insulin or sulphonylureas can be at particular risk of severe hypoglycemia, which is when blood sugar levels fall very low. Severe hypos require assistance from others to treat, and can be caused by a variety of factors.
Researchers from the University of Minnesota set about developing a model to predict a person’s long-term risk of severe hypos, with a view towards helping doctors to prevent them.
They created the model using data from the Action to Control Cardiovascular Risk in Diabetes (ACCORD) study. This study evaluated how effective lowering blood sugar, particularly with stronger medication, would be towards lowering heart disease risk in type 2 diabetes.
A total of 17 predictors were identified to construct a model for severe hypoglycemia. The strongest three predictors over five years were intensive blood sugar management, insulin use and antihypertensive (blood pressure) medication. In this instance, intensive blood sugar management referred to using strong diabetes medications to attempt to reduce HbA1c levels to lower than 42 mmol/mol (6.5%)
The intensive blood sugar management was associated with the highest risk of severe hypos, followed by the use of insulin. For these participants, the risk of severe hypos was twice as high compared to non-users according to the predictive model.
The next highest factor was blood pressure medications. Those who took blood pressure drugs were nearly twice as likely to experience severe hypos.
The researchers concluded that the model “warrants evaluation in broader populations” to determine whether the model holds up in predicting severe hypo risk.
For people with type 2 diabetes who take glucose-lowering or blood pressure medication and may be concerned about hypo risks, consult with your doctor if you believe your treatment may need to be altered.
The study highlights that strong medication, like sulphonylureas and insulin, can lead to greater risks of severe hypos. In 2015, we launched the Low Carb Program which has helped many people to improve their sugar levels whilst reducing their dependency on medication. This is a great result for those that have achieved this as it provides greater health with lower risks of severe hypos.
The model’s outcomes have been published online in BMJ Open Diabetes Research and Care.

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