Patient Benefits   Helping to achieve HbA1c targets   Minimise unexplained hypoglycaemia   Lower risk of Glycaemic variation   Injection comfort and adherence


Minimise the risk of unexplained hypoglycaemia

The consequences of unexplained hypoglycaemia can be severe, impacting patients, family and friends, healthcare workers, the healthcare system and the wider health economy. In an article published in the British Journal of Diabetes & Vascular Disease in 20111, Frier et al. highlighted the morbity associated with diabetes related hypoglycaemia :

  • Neurological
    • Coma, convulsions, hemiplegia, transient ischaemic events, focal lesions, cognitive impairment
  • Cardiac
    • Arrhythmias
    • Myocardial ischaemia/infarction
    • Cardiac failure
  • Accidents
    • Fractures/joint dislocations, head injuries
    • Soft-tissue injuries
    • Road traffic accidents (related to driving)


“This survey supports previous studies in demonstrating that severe hypoglycaemia involves a major cost burden on healthcare systems. This includes direct costs for hospitals, emergency departments, emergency ambulance services and primary care services”.

“Direct costs are especially high for the minority of episodes that result in hospital admission, but substantial costs are also generated by calling out emergency ambulance or primary care services which accounts for a higher absolute number of severe hypoglycaemic events”.

“Measures designed to reduce the overall incidence of severe hypoglycaemic events have the potential to save considerable healthcare costs, while greatly improving the quality of life of patients with both type 1 and type 2 diabetes”.

Frier et al.1 defined Severe Hypoglycaemia Event (SHE) as needing third party assistance. In his study in the UK, he found that:

  • 28% of documented SHE lead to Hospitalisation resulting in 230 bed days
  • 34% of SHE were successfully treated by Ambulance and Paramedic
  • 52% of SHE required help of both emergency departments and primary care
  • Total estimated direct cost of SHE in Tayside was £92,078 in one year
  • The 52 SHE that resulted in hospitalisation accounted for over 54% of total cost


By extrapolating data for Tayside, a healthcare region within the UK, Frier1 estimated that SHE costs Healthcare Service ≤£13 million per year

Costs of managing severe hypoglycaemia in three European countries

According to Hammer2, SHE treatment adds significantly to healthcare costs. Average costs were lower for T1DM than T2DM in all three countries

Average SHE treatment costs for T2DM

  • Germany €533
  • Spain €691
  • UK €537


Average SHE treatment costs for T1DM

  • Germany €441
  • Spain €577
  • UK €236


Costs of managing SHE can be significant


Unexplained Hypoglycaemia - clinical case study by UK diabetes specialist nurse Linda Clapham3

Clinical base-line characteristics and medical history:

  • 63 year old man - HbA1c 8%
  • History of severe hypoglycaemia with multiple ambulance calls for several years
  • Stated along with wife that injection sites were healthy & declined to have them examined
  • December 2013 another severe hypoglycaemia, crashed car, multiple injuries, car destroyed, patient hospitalized
  • Seen by DSN, Linda and empowered to consent to injection site examination
  • Large lipohypertrophy lesions found on inner thighs and abdomen

Outcome after optimal injection technique intervention:

  • Total daily dose (TDD) had reduced from 112 units to 52 units per day
  • HbA1c was unchanged (8%) despite over 50% reduction in TDD
  • Blood glucose readings were significantly more stable
  • 70% of his blood glucose levels were in target range, with only one reading of 3.8 mmol/L
  • No reported unexplained hypoglycaemia
Unexplained Hypoglycaemia example
Reproduced with kind permission of Linda Clapham


  • 1 Frier B. et al. The economic costs of hypoglycaemia. British Journal of Diabetes & Vascular Disease Vol 11, Suppl 1. Jan/Feb 2011. 10-11
  • 2 Hammer M et al. Costs of managing severe hypoglycaemia in three European countries. Journal of Medical Economics. 2009. 12(4): 281-290
  • 3 Clapham L (2015) Injection technique education and follow-up; The key to ensuring optimal glycaemic control. Journal of Diabetes Nursing 19: 152-5
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