TOPLINE:

In a nationwide cohort study of patients with newly diagnosed diabetes, hospitalisations for severe hypoglycaemia among those with pancreatic diabetes dropped significantly from 2003-2006 to 2019-2022. Shifts in treatment patterns, including the increased use of metformin and the transition from human insulin to analogues, likely contributed to this substantial decline, although patients with pancreatic diabetes remained at a notable risk for hypoglycaemia.

METHODOLOGY:

• Researchers in Denmark conducted a nationwide retrospective cohort study using linked national registries to examine whether the incidence of hypoglycaemia in patients with pancreatic diabetes declined after the advent of modern glucose-lowering medications.
• They identified 583,220 patients with new-onset diabetes diagnosed between January 1998 and December 2022, of whom 3383 had pancreatic diabetes (mean age, 57.9 years; 68.8% men), 12,383 had type 1 diabetes (T1D; mean age, 45.4 years; 62.6% men), and 567,454 had type 2 diabetes (T2D; mean age, 58.2 years; 49.2% men).
• Outcomes were changes in the incidence of severe hypoglycaemic events that led to hospitalisation across all diabetes subtypes, treatment patterns of glucose-lowering medications in patients with pancreatic diabetes, and associations between these medications and the risk for the first severe hypoglycaemic event.
• The median follow-up duration was 4.9 years for pancreatic diabetes, 7.6 years for T1D, and 6.6 years for T2D.

TAKEAWAY:

• The incidence of severe hypoglycaemia declined across all diabetes subtypes, with the incidence of pancreatic diabetes seeing the largest reduction (69%; incidence rate ratio, 0.31; 95% CI, 0.25-0.40), followed by T2D (65%) and T1D (57%).
• Nevertheless, patients with pancreatic diabetes remained at the highest risk, with an incidence rate of 2.21 severe hypoglycaemia episodes per 100 person-years during 2019-2022 vs 1.49 and 0.19 for T1D and T2D, respectively.
• During the same period, prescription patterns changed markedly among patients with pancreatic diabetes, including a shift from human insulin to insulin analogues, a decline in the use of sulfonylureas, and a rise in the use of metformin.
• Treatment with metformin was associated with a reduced risk for severe hypoglycaemia in patients with pancreatic diabetes, whereas the use of any type of insulin was linked to an increased risk for it.

IN PRACTICE:

"While the pathophysiology of pancreatic diabetes remains complex and requires careful consideration when glucose-lowering medications are initiated or adjusted, the observed decline in hypoglycaemia risk may support a more individualised approach with tighter glycaemic targets in selected patients," the authors wrote. 

SOURCE:

The study was led by Line Davidsen, MD, Centre for Pancreatic Diseases and Mech-Sense, Department of Gastroenterology and Hepatology, Aalborg University Hospital, Aalborg, Denmark. It was published online on September 08, 2025, in Diabetes, Obesity and Metabolism. 

LIMITATIONS:

The study relied on hospitalisation records to identify hypoglycaemic episodes, potentially underestimating the true burden. The use of dispensed prescriptions as a proxy for exposure to glucose-lowering drugs may not have fully reflected patient adherence or actual medication use. Additionally, uncommon forms of diabetes, including drug-induced diabetes, were not excluded and were likely classified as T2D.

DISCLOSURES:

The study did not receive any funding.The authors reported having no relevant conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.