{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T14:10:54Z","timestamp":1787062254067,"version":"build-2736575974"},"reference-count":34,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2018,3,2]],"date-time":"2018-03-02T00:00:00Z","timestamp":1519948800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J of Diabetes Invest"],"published-print":{"date-parts":[[2018,5]]},"abstract":"Abstract<\/jats:title>\n \n Despite great strides in pharmacotherapy for diabetes, there is increasing concern over the risk of hypoglycemia in patients with diabetes receiving pharmacotherapy as they become increasingly older. This has prompted the Japan Diabetes Society (\n JDS<\/jats:styled-content>\n ) to initiate a survey on the current status of severe hypoglycemia in clinical settings. In July 2015, following approval from the\n JDS<\/jats:styled-content>\n Scientific Survey\/Research Ethics Committee, the\n JDS<\/jats:styled-content>\n extended an invitation to executive educators, who represented a total of 631 healthcare facilities accredited by the\n JDS<\/jats:styled-content>\n for diabetes education, to participate in the proposed survey. Of these, those who expressed their willingness to participate in the survey were sent an application form required for obtaining ethical approval at these healthcare facilities and were then asked, following approval, to enter relevant clinical data on an unlinked, anonymous basis in a web\u2010based registry. The current survey was fully funded by the\n JDS<\/jats:styled-content>\n Scientific Survey\/Research Committee. A case registry (clinical case database) was launched after facility\u2010specific information (healthcare facility database) was collected from all participating facilities and after informed consent was obtained from all participating patients. With severe hypoglycemia defined as the \u201cpresence of hypoglycemic symptoms requiring assistance from another person to treat and preferably venous plasma glucose levels at onset\/diagnosis of disease or at presentation clearly less than 60\u00a0mg\/\n dL<\/jats:styled-content>\n (capillary whole blood glucose, less than 50\u00a0mg\/\n dL<\/jats:styled-content>\n )\u201d, the current survey was conducted between April 1, 2014 and March 31, 2015, during which facility\u2010specific information was collected from a total of 193 facilities with a total of 798 case reports collected from 113 facilities. Of the 193 respondent facilities, 149 reported having an emergency department as well, with the median number of patients who required emergency transportation services to reach these facilities totaling 4,962 annually, of which those with severe hypoglycemia accounted for 0.34% (17). The respondent facilities accommodated a total of 2,237 patients with severe hypoglycemia annually, with the number of patients thus accommodated being 6.5 patients per site. A total of 1,171 patients were admitted for severe hypoglycemia, with the number of patients thus admitted being 4.0 per site, who accounted for 52.3% of all patients visiting annually for severe hypoglycemia. A review of the 798 case reports collected during the survey revealed that 240, 480 and 78 patients had type 1 diabetes, type 2 diabetes, and other types of diabetes, respectively; those with type 2 diabetes were shown to be significantly older (median [interquartile range], 77.0 [68.0\u201383.0]) than those with type 1 diabetes (54.0 [41.0\u201367.0]) (\n P\u00a0<\/jats:italic>\n <\n \u00a0<\/jats:italic>\n 0.001); and the\n BMI<\/jats:styled-content>\n was shown to be significantly higher for those with type 2 diabetes (22.0 [19.5\u201324.8] kg\/m\n 2<\/jats:sup>\n ) than for those with type 1 diabetes (21.3 [18.9\u201324.0] kg\/m\n 2<\/jats:sup>\n ) (\n P\u00a0<\/jats:italic>\n =\n \u00a0<\/jats:italic>\n 0.003). It was also found that the median estimated glomerular filtration rate (\n eGFR<\/jats:styled-content>\n ) was significantly lower among those with type 2 diabetes (50.6\u00a0\n mL<\/jats:styled-content>\n [31.8\u201371.1]\/min\/1.73\u00a0m\n 2<\/jats:sup>\n ) than among those with type 1 diabetes (73.3 [53.5\u201391.1]\n mL<\/jats:styled-content>\n \/min\/1.73 m\n 2<\/jats:sup>\n ) (\n P\u00a0<\/jats:italic>\n <\n \u00a0<\/jats:italic>\n 0.001). Again, the median HbA1c value at onset of severe hypoglycemia was shown to be 7.0 (6.3\u20138.1)% among all patients examined, 7.5 (6.9\u20138.6)% among those with type 1 diabetes, and 6.8 (6.1\u20137.6)% among those with type 2 diabetes, with the HbA1c value at onset of hypoglycemia being significantly lower among those with type 2 diabetes (\n P\u00a0<\/jats:italic>\n <\n \u00a0<\/jats:italic>\n 0.001). Antecedent symptoms of severe hypoglycemia were shown to be present, absent and unknown in 35.5, 35.6, and 28.9% of all patients, respectively, with the incidence of symptomatic hypoglycemia being significantly lower among those with type 1 diabetes (41.0%) than among those with type 2 diabetes (56.9%). The antidiabetic agents used in those with type 2 diabetes were insulin preparations (292 patients including 29 receiving concomitant sulfonylureas [\n SU<\/jats:styled-content>\n s]) (60.8%),\n SU<\/jats:styled-content>\n s (159 insulin\u2010na\u00efve patients) (33.1%), and no insulin preparations or\n SU<\/jats:styled-content>\n s (29 patients) (6.0%). Of the 798 patients surveyed, 296 patients (37.2%) were shown to have required emergency transportation services for severe hypoglycemia before. Thus, the survey revealed, for the first time, the current status of treatment\u2010related severe hypoglycemia in Japan and clearly highlights the acute need for implementing preventive measures against hypoglycemia not only through education on hypoglycemia but through optimization of antidiabetic therapy for those at high risk of severe hypoglycemia or those with a history of severe hypoglycemia.\n <\/jats:p>","DOI":"10.1111\/jdi.12790","type":"journal-article","created":{"date-parts":[[2018,3,2]],"date-time":"2018-03-02T01:42:52Z","timestamp":1519954972000},"page":"642-656","source":"Crossref","is-referenced-by-count":28,"title":["The current status of treatment\u2010related severe hypoglycemia in Japanese patients with diabetes mellitus: A report from the committee on a survey of severe hypoglycemia in the Japan Diabetes Society"],"prefix":"10.1111","volume":"9","author":[{"given":"Mitsuyoshi","family":"Namba","sequence":"first","affiliation":[{"name":"Hyogo College of Medicine College Hospital Nishinomiya Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Toshio","family":"Iwakura","sequence":"additional","affiliation":[{"name":"Diabetes and Endocrinology Kobe City Medical Center General Hospital Kobe Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rimei","family":"Nishimura","sequence":"additional","affiliation":[{"name":"Department of Diabetes, Metabolism and Endocrinology Jikei University School of Medicine Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kohei","family":"Akazawa","sequence":"additional","affiliation":[{"name":"Department of Medical Informatics Niigata University Medical & Dental Hospital Niigata Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Munehide","family":"Matsuhisa","sequence":"additional","affiliation":[{"name":"Diabetes Therapeutics and Research Center Institute of Advanced Medical Sciences Tokushima University Tokushima Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yoshihito","family":"Atsumi","sequence":"additional","affiliation":[{"name":"Diabetes Center Eiju General Hospital Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jo","family":"Satoh","sequence":"additional","affiliation":[{"name":"Tohoku Medical and Pharmaceutical University Wakabayashi Hospital Sendai Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Toshimasa","family":"Yamauchi","sequence":"additional","affiliation":[{"name":"Department of Diabetes and Metabolic Diseases Graduate School of Medicine University of Tokyo Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"the Japan Diabetes Society (JDS) Committee for Surveys on Severe Hypoglycemia","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2018,3,2]]},"reference":[{"key":"e_1_2_7_2_1","first-page":"826","article-title":"The current status of treatment\u2010related severe hypoglycemia in Japanese patients with diabetes mellitus: A report from the committee on a survey of severe hypoglycemia in the Japan Diabetes Society","volume":"60","author":"Namba M","year":"2017","journal-title":"J Japan Diabet Soc"},{"key":"e_1_2_7_3_1","first-page":"667","article-title":"Cause of death in Japanese patients with diabetes based on the results of survey of 45,708 cases during 2001\u20132010","volume":"59","author":"Nakamura J","year":"2016","journal-title":"J Japan Diabet Soc"},{"key":"e_1_2_7_4_1","first-page":"47","article-title":"A questionnaire survey on the causes of death in 18,385 Japanese patients with diabetes mellitus during the 10\u00a0years between 1991\u00a0and 2000","volume":"50","author":"Hotta N","year":"2007","journal-title":"J Japan Diabet Soc"},{"key":"e_1_2_7_5_1","doi-asserted-by":"publisher","DOI":"10.2337\/dc08-9026"},{"key":"e_1_2_7_6_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamainternmed.2013.6176"},{"key":"e_1_2_7_7_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1464-5491.2011.03505.x"},{"key":"e_1_2_7_8_1","unstructured":"Statistics Bureau Ministry of Internal Affairs and Communication of Japan (2015) Number of emergency transportation services ordered for 2014 (flash report)Available from:http:\/\/www.fdma.go.jp\/neuter\/topics\/houdou\/h27\/03\/270331_houdou_2.pdf. 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