American Diabetes Association
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Ambient Heat and Risk of Serious Hypoglycemia in Older Adults with Diabetes using Insulin in the U.S. and Taiwan: A Cross-National Case Crossover Study

posted on 2023-12-07, 17:09 authored by Aayush Visaria, Shu-Ping Huang, Chien-Chou Su, David Robinson, John Read, Chuan-Yao Lin, Rachel Nethery, Kevin Josey, Poonam Gandhi, Benjamin Bates, Melanie Rua, Ashwagosha Parthasarathi, Arnab K. Ghosh, Yea-Huei Kao Yang, Soko Setoguchi

Objective: To measure the association between ambient heat and hypoglycemia-related ED visit or hospitalization in insulin users.

Research Design and Methods: We identified cases of serious hypoglycemia among adults using insulin aged ≥65 in the US (via Medicare Part A/B/D-eligible beneficiaries) and Taiwan (via National Health Insurance Database) from June to September, 2016-2019). We then estimated odds of hypoglycemia by heat index (HI) percentile categories using conditional logistic regression with a time-stratified case-crossover design.

Results: Among ~2 million insulin users in the US (32,461 hypoglycemia cases), ORs for HI >99th, 95-98th, 85 94th, and 75-84th percentiles compared to the 25-74th percentile were 1.38 (95% CI, 1.28-1.48), 1.14 (1.08-1.20), 1.12 (1.08-1.17), and 1.09 (1.04-1.13) respectively. Overall patterns of associations were similar for insulin users in the Taiwan sample (~283,000 insulin users, 10,162 hypoglycemia cases).

Conclusions: In two national samples of older insulin users, higher ambient temperature was associated with increased hypoglycemia risk.


Funding for this study was provided by the National Institute on Aging, National Institutes of Health (R01 #1R01AG060232-01A1).


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