OBJECTIVES : To conduct a literature review of real-world costs associated with hypoglycemia in patients with type 2 diabetes.

METHODS : A literature search was conducted using PubMed (2009-2017). Inclusion criteria were English language observational studies of type 2 diabetes where costs or key resource use measures of hypoglycemic events (direct and/or indirect) were reported. Studies with a sample size of <100 patients were excluded, along with studies that did not describe how costs were determined.

RESULTS : After screening 543 abstracts, 46 were selected for full text review, of which 15 specifically used retrospective cohorts and/or claims databases representing 4 countries (11 United States; 3 Italy; 2 United Kingdom; 1 Spain). Eight studies reported hypoglycemic costs for the study population, while the remainder compared hypoglycemic costs associated with different antihyperglycemic agents. Total medical costs were 60% higher in patients with hypoglycemic events versus those without hypoglycemic events. The mean direct costs for a hypoglycemic event were US$951-US$2,683. Hypoglycemia-related inpatient admissions ranged from US$1,577-$17,564/EU€308-€7,688, emergency department visits US$110-$1,386/EU €23-€143, and physician visits US$100-$145/EU€6-€7. Hospitalization costs were the primary cost driver, accounting for 74-87% of direct costs. Patients who required hospitalization for hypoglycemia as an outpatient had lengths of stay of 2-5 days, while inpatient hypoglycemia had an incremental length of stay of 6-7 days. Patients on insulin therapy had ~5x higher hypoglycemia-related costs than patients on non-insulin antihyperglycemic therapies. There was limited direct cost data comparing non-insulin antihyperglycemic agents, and few studies reported indirect costs.

CONCLUSIONS : Occurrence of hypoglycemic events increases costs for patients with type 2 diabetes and these vary by region. Additional research to determine hypoglycemic costs by antihyperglycemic regimen, and the impact of indirect costs is needed. An accurate estimate of hypoglycemia costs may assist with determining the value of diabetes management practices.