A probabilistic model for predicting hypoglycemia in type 2 diabetes mellitus: The diabetes outcomes in veterans study (DOVES)

Abstract

Background: To develop and validate a method for estimating hypoglycemia risk in stable, insulin-treated subjects with type 2 diabetes mellitus. Methods: Subjects (n = 195) monitored their blood glucose levels 4 times daily for 8 weeks. An 8-week mean blood glucose value (GLUMEAN) with standard deviation (GLUSD) was derived for each patient. Subjects were then randomly allocated to a derivation or validation set. For the derivation set, we developed a logistic function based on GLUMEAN and GLUSD to describe the 8-week risk of hypoglycemia (blood glucose ≤60 mg/dL [3.3 mmol/L]). This function was used to assign a predicted probability of hypoglycemia to each subject in the validation set. Subjects were assigned to risk quartiles and followed up for up to 52 weeks. Results: We evaluated 195 subjects, 95% of whom were men and 69% of whom were non-Hispanic white. For 72 derivation subjects, GLUMEAN and GLUSD were highly influential determinants of hypoglycemia during intensified monitoring. The 123 validation subjects were followed up for 39.7 ± 7.1 weeks (mean ± SD). The occurrence of long-term hypoglycemia differed significantly across risk quartiles (19.4%, 36.7%, 61.3%, and 77.4%, respectively; P