A team led by Kaiser Permanente researchers in co-operation with FDA has developed and validated a practical tool for identifying diabetes patients who are at the highest risk for being admitted to an emergency department or hospital due to severe hypoglycemia, or very low blood sugar. Their results are published in JAMA Internal Medicine.

The researchers developed the hypoglycemia risk tool by identifying 156 possible risk factors for hypoglycemia and collecting data from more than 200,000 patients with type 2 diabetes receiving care from Kaiser Permanente in Northern California. Using machine-learning analytical techniques, they developed a model to predict a patient's 12-month risk of hypoglycemia-related emergency department or hospital use.

The final model was based on six variables: number of prior episodes of hypoglycemia-related emergency department visits or hospitalizations; use of insulin; use of sulfonylurea (an oral medication commonly used to treat diabetes); severe or end-stage kidney disease; number of emergency room visits for any reason in the past year; and age.

Based on the model, the researchers created a practical tool to categorize patients into high (greater than 5 percent), intermediate (1 to 5 percent) or low (less than 1 percent) annual risk of hypoglycemia-related emergency department or hospital utilization. The tool was then validated with data from more than 1.3 million members of the U.S. Veterans Health Administration and nearly 15,000 Kaiser Permanente members in Washington state with type 2 diabetes.

The U.S. Food and Drug Administration (FDA) funded the development of the tool. The results are being disseminated with help from the Centers for Medicare and Medicaid Services (CMS).

Several public and private health care systems and organizations are now examining how they can use the tool to increase awareness about hypoglycemia and bring attention and resources to help patients with type 2 diabetes avoid dangerous episodes in the future.The study was carried out at two diabetes clinics at hospitals in the Midlands and involved 230 patients with Type 2 diabetes.

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