Diabetes progression and severe hypoglycemia: a nationwide cohort study of 2,475,605 adults with type 2 diabetes mellitus.

BACKGROUND/AIMS: Severe hypoglycemia (SH) is a major concern in type 2 diabetes mellitus (T2DM). We evaluated whether a composite diabetes progression score could predict incident SH. METHODS: Using the Korean National Health Insurance Service database, we identified 2,475,605 adults with T2DM who underwent health examinations in 2015-2016. Incident SH was defined by ICD-10 codes plus emergency department visit or hospitalization. The progression score (range, 0-6) comprised six indicators: longer diabetes duration, use of ≥ 3 oral glucose-lowering drug classes, insulin use, chronic kidney disease (CKD), cardiovascular disease, and diabetic retinopathy. RESULTS: During 1 year of follow-up, 1,186 SH events occurred. Each component of diabetes progression was independently insuassociated with SH risk hazard ratios (HRs) from 1.19-3.27, with insulin use and CKD showing the largest effects. SH risk increased stepwise with higher progression scores. Compared with a score of 0, the adjusted HRs (95% confidence intervals) were 3.35 (2.63-4.27), 7.74 (6.15-9.74), 12.61 (9.97-15.95), 22.39 (17.44-28.75) for scores 1, 2, 3, and ≥ 4, respectively. CONCLUSION: A concise diabetes progression score strongly stratified short-term SH risk in this nationwide cohort, and may help target proactive prevention and early intervention.