Predicting Emergency Department or Hospital Visits in T2D Adverse Events

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Over 150 variables were identified as possible hypoglycemia risk factors.

A team of researchers from Kaiser Permanente has created a risk stratification tool that can identify patients with type 2 diabetes (T2D) at greatest risk for hypoglycemia-related emergency department (ED) or hospital use. Findings from this study were published in JAMA Internal Medicine.

Hypoglycemia is a common adverse event in patients with T2D, and is often associated with glucose-lowering medications. Using data from over 200,000 people with T2D, the researchers identified 156 possible risk factors for hypoglycemia, and through “machine-learning analytical techniques,” were able to create a model to predict a patient’s 12-month risk of hypoglycemia-related ED or hospital use.

The final model was based on 6 patient-specific variables: number of prior episodes of hypoglycemia-related ED visits or hospitalizations; insulin use; sulfonylurea use; severe or end-stage kidney disease; number of ED visits for any reason in the past year; and age. 

Based on these variables, the researchers categorized patients into high (>5%), intermediate (1% to 5%), and low (<1%) risk groups. They then validated the tool using data from over 1.3 million members of the US Veterans Health Administration and around 15,000 Kaiser Permanente members with T2D. The accuracy of the model was assessed in the internal validation sample (n=41,287); 2% were considered high risk, while 10.7% and 87.3% were considered intermediate and low risk, respectively. The observed 12-month hypoglycemia-related utilization rates for these groups were 6.7%, 1.4%, and 0.2%, respectively.

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“This tool could be integrated with targeted preventive interventions to facilitate population management, which ultimately could reduce future hypoglycemia risk and improve patient safety,” the authors write. They note that while the 2 criteria for high risk patients may be easily memorized by clinicians (≥3 previous episodes of hypoglycemia-related utilization; 1 or 2 episodes if treated with insulin), “the criteria for intermediate risk are more nuanced and therefore may be less likely to provoke clinical action in primary care without prompting.” 


Karter AJ, Warton EM, Lipska KJ, et al. Development and validation of a tool to identify patients with type 2 diabetes at high risk of hypoglycemia-related emergency department or hospital use [published online August 21, 2017]. JAMA Intern Med. doi:10.1001/jamainternmed.2017.3844

This article originally appeared on MPR