Different drug treatments may induce severe hypoglycemia to type 2 diabetes mellitus patients

Objective Severe hypoglycemia is a severe side effect of type 2 diabetes (T2D), which is able to increase the burden of psychological, physiological and economy in the patients. To address which populations of T2D patients are susceptible to severe hypoglycemia, we classified the T2D patients into different groups based on the clinical guidelines developed by the American Diabetes Association. Specifically, this study aims to explore the causal associations between the combinations of antidiabetic drugs and severe hypoglycemia. Methods We used the data collected from the National Health Insurance Research database (NHIRD) during 2008-2011 in Taiwan. This study employed a nested case-control study design to investigate the newly diagnosed T2D patients. Severe hypoglycemia case group was defined as the patients underwent the hypoglycemia and sought the help from a hospital. For the case group, the date for the hospitalization or the event was called as the index date; whereas, for the control group, the last day of the following day in the studied period was defined as the index date. To analyze the associations of the combinations of drugs and severe hypoglycemia, a Cox hazard regression model was utilized. Results To minimize the potential biases from confounding factors, we matched the case group by using the propensity score method based on the one to fourth design. The results revealed 204 cases with severe hypoglycemia and 816 matched controls. Statistical analysis of the associations between drug combinations and hypoglycemia revealed the highest odds ratio (9.63, 95% CI: 4.40-21.08) in the T2D patients concurrently using insulin and other drugs. Similar high odds ratio (12.67, 95% CI: 4.15-38.62) was observed in the elder T2D patients, whose age was higher than 65. Conclusion The results of this study indicated that the T2D patients from the NHIRD had a higher proportion to take oral drugs and intriguingly most patients in the case group of hypoglycemia used multiple drugs simultaneously. The statistical results showed that the T2D patients had the highest odds ratio while concurrently using insulin and other drugs. The same phenomenon can be observed in the elder T2D patients, whose age was higher than 65. Consequently, we shall provide detailed health education for the T2D patients to prevent the occurrence of hypoglycemia while they concurrently use insulin and other drugs.