Severe hypoglycaemia twice as likely in adults living with diabetes and food insecurity

New research has found that severe hypoglycaemia is over two times more frequent in people with diabetes who struggle to afford food.

Severe hypoglycaemia is when a person experiences loss of consciousness, seizures, coma and, in rare cases, death due to a fall in their blood sugar levels.

An analysis of data was recently presented at EASD and found that people with diabetes who experience food insecurity are 2.2 times more likely to suffer from severe hypoglycaemia.

Although it is known that food insecurity effects health, there is minimal real-world population-based research into how it influences severe hypoglycaemia rates.

Researchers from Western University in Ontario, Canada, conducted a first of its kind study analysing data from the US-wide iNPHORM study: a 12-month prospective panel survey of real-world hypoglycaemia risk.

Dr Ratzki-Leewing, of Western University, explained: “This is the first community-based, prospective study to look at the impact of food insecurity on rates of Level 3 (severe) hypoglycaemia in adults in the US with diabetes on insulin and/or secretagogues.

“We showed that food insecurity is alarmingly common across this population and that it more than doubles the rate of severe hypoglycaemia.”

The research analysed data from 1,001 participants, 16.1 per cent of which had type 1 diabetes and 83.9 per cent of which had type 2 diabetes and were treated for at least a year with insulin and/or secretagogues – two commonly prescribed classes of diabetes drug which increase the risk of severe hypoglycaemia as a side-effect.

The average age of participants was 51 and they had lived with diabetes for an average of 12 years.

Participants completed monthly questionnaires for 12 months starting from spring 2020. This data allowed researchers to assess the participants’ characteristics and frequency of severe hypoglycaemia, which was defined using the American Diabetes Association Standards of Care guidelines.

“In the short term, severe hypoglycaemia can cause dangerous symptoms (such as seizures and coma) and accidents. It can also lead to impaired awareness of hypoglycaemia (the diminished ability to perceive falling blood glucose levels), which in turn, can increase the risk of future hypoglycaemia events,” said Dr Ratzki-Leewing. “Long-term, severe hypoglycaemia has been associated with nerve and heart damage, as well as premature mortality. These effects have substantial direct and indirect economic costs.”

As part of the first questionnaire, respondents were asked, “Within the past 12 months, did you ever cut the size of your meals or skip meals because there was not enough food?”. The people who replied “yes” were classed as having experienced food insecurity.

Approximately 20 per cent of the participants had experienced food insecurity – 18.6 per cent of those with type 1 diabetes and 20.4 per cent of those with type 2 diabetes.

More than 50 per cent of these individuals had experienced at least one Level 3 event in the previous 12 months.

To establish whether food insecurity increased the rates of severe hypoglycaemia, the researchers performed multivariable regression.

After adjusting for factors such as age, annual gross household income, insurance coverage, living arrangements and diabetes type, the results revealed that participants who experienced food insecurity had just over twice as many severe hypoglycaemia events during the 12-month study period compared to those did not experience food insecurity.

Dr Ratzki-Leewing said: “We recommend clinicians use our screening question and exercise vigilance when managing individuals with food insecurity prescribed insulin or secretagogues. Public health strategies to address food insecurity are also vital to prevent severe hypoglycaemia and its profound consequences.”

She concluded: “Ultimately, our study uncovers a key opportunity to reduce the burden of diabetes-related severe hypoglycaemia, while improving overall health. The results are timely given the rising cost of living, not only in the US but also globally.”