High rates of severe hypoglycemia among African American patients with diabetes: the surveillance, prevention, and Management of Diabetes Mellitus (SUPREME-DM) network.
OBJECTIVE
Seven-year surveillance study (2005-2011) to evaluate race/ethnic differences in the trends in rates of severe hypoglycemia (SH) in a population of insured, at-risk adults with diabetes.


METHODS
SH events were identified via any primary or principal diagnosis from emergency department or inpatient encounters among African American, Asian, Latino and White adult diabetes patients treated with insulin or secretagogues (Sulfonylureas or Meglitinides), receiving care from integrated healthcare delivery systems across the United States. We calculated age- and sex-standardized annual SH rates and average annual percent change (AAPC) in SH rates.


RESULTS
Annual SH rates ranged from 1.8% to 2.1% during this 7-year observation period (2,200,471 person-years). African Americans had consistently higher SH rates compared with Whites, while Latinos and Asians had consistently lower rates compared with Whites in each of the 7 years (all p < 0.01). The trend increased significantly only among African Americans (AAPC = +4.3%; 95% CI: +2.1, +6.5%); in the other groups, the AAPC was not significantly different from zero.


CONCLUSIONS
Surveillance efforts should monitor the racial/ethnic-specific rates. The factors underlying substantially higher rates of hypoglycemia in African Americans should be evaluated. Clinically and culturally-appropriate strategies to reduce the risk of SH need to be developed and tested.
Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA 94612. Electronic address: andy.j.karter@kp.org.
Andrew J
AJ
Karter
Section of Endocrinology, Department of Internal Medicine, Yale School of Medicine, PO Box 208020, New Haven, CT 06520.
Kasia J
KJ
Lipska
HealthPartners Institute, P.O. Box 1524, Minneapolis, MN 55440.
Patrick J
PJ
O'Connor
Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA 94612.
Jennifer Y
JY
Liu
Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA 94612.
Howard H
HH
Moffet
Institute for Health Research, Kaiser Permanente Colorado, PO Box 378066, Denver, CO 80237.
Emily B
EB
Schroeder
Department of Research and Evaluation, Kaiser Permanente Southern California, 100 South Los Robles Avenue, 2nd Floor, Pasadena, CA 91101.
Jean M
JM
Lawrence
Kaiser Permanente Center for Health Research, Kaiser Permanente Northwest, 3800 N. Interstate Avenue, Portland, OR 97227.
Gregory A
GA
Nichols
Group Health Research Institute, 1730 Minor Ave, Suite 1600, Seattle, WA 98101.
Katherine M
KM
Newton
Department of Endocrinology, Marshfield Clinic, 1000 North Oak Avenue, Marshfield, WI 54449.
Ram D
RD
Pathak
HealthPartners Institute, P.O. Box 1524, Minneapolis, MN 55440.
Jay
J
Desai
Center for Health Research, Kaiser Permanente Hawaii, 501 Alakawa Street, Suite 201, Honolulu, HI 96817.
Beth
B
Waitzfelder
Center for Clinical and Outcomes Research, Kaiser Permanente Georgia, 3495 Piedmont Road NE, Building 11, Suite 110, Atlanta, GA 30305.
Melissa G
MG
Butler
Department of Medicine, New York University (NYU) Lutheran, 150 55th St, Brooklyn, NY 11220.
Abraham
A
Thomas
Institute for Health Research, Kaiser Permanente Colorado, PO Box 378066, Denver, CO 80237.
John F
JF
Steiner
D000293:Adolescent; D000328:Adult; D001741:Black or African American; D000367:Age Factors; D015331:Cohort Studies; D003131:Combined Modality Therapy / Q000009:adverse effects; D019033:Delivery of Health Care, Integrated; D003920:Diabetes Mellitus / Q000097:blood / Q000208:ethnology / Q000628:therapy*; D005260:Female; D054624:Health Status Disparities; D006801:Humans; D007003:Hypoglycemia / Q000453:epidemiology / Q000208:ethnology / Q000503:physiopathology / Q000517:prevention & control*; D008297:Male; D008329:Managed Care Programs; D008875:Middle Aged; D011159:Population Surveillance; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D012737:Sex Factors; D014481:United States / Q000453:epidemiology; D055815:Young Adult
Complications; Hypoglycemia; Insulin; Insulin secretagogues; Racial differences; Sulfonylureas