Low Income Tied to Higher Risk of Severe Hypoglycemia in Type 2 Diabetes, Study Finds
South Korea: A large-scale cohort study published in JAMA Network Open highlights a strong connection between income levels and the risk of severe hypoglycemia in individuals with type 2 diabetes. Conducted by Dr. Misook Kim from the Division of Endocrinology and Metabolism, Seoul St Mary’s Hospital, The Catholic University of Korea, and colleagues, the research emphasizes the pressing need to address socioeconomic disparities to enhance diabetes care and reduce adverse outcomes.
The study analyzed data from over 1.8 million adults with type 2 diabetes in South Korea, sourced from the Korean National Health Information Database (NHID), and included a comparative sensitivity analysis of more than 17,000 participants from the UK Biobank (UKBB). All individuals were aged between 40 and 70 years and had valid income and health information.
Researchers explored how both absolute income levels and changes in income over time influenced the likelihood of experiencing severe hypoglycemia, an acute and dangerous drop in blood sugar requiring medical intervention.
The study led to the following findings:
- Individuals in the lowest income groups had a significantly higher risk of severe hypoglycemia compared to those with higher incomes in both Korean and UK cohorts.
- In the Korean cohort, low-income individuals had a 2.5-fold increased risk of severe hypoglycemia.
- In the UK cohort, the risk of severe hypoglycemia was over five times higher among those with low income.
- The duration of low income was found to be an important factor, with those receiving medical aid or staying in low-income brackets for at least one year showing an even greater risk.
- Participants whose income improved over five years, from the lowest quartile or medical aid status to the highest income group, had a 26% lower risk of severe hypoglycemia.
- The link between income and hypoglycemia risk was more prominent in men than in women.
- The association remained significant among individuals not using insulin therapy.
- The risk pattern also held true for those without chronic kidney disease.
- Individuals with a shorter duration of diabetes also showed a stronger income-related risk of hypoglycemia.
- The findings indicate that both biological factors and disparities in healthcare access may contribute to the increased risk among low-income individuals.
The authors emphasized that socioeconomic status should be considered a critical component in diabetes risk assessment and management strategies. They advocate for policy-level interventions and community-based programs aimed at improving financial stability for low-income individuals with diabetes.
"The extensive study highlights the influence of economic factors on health outcomes in type 2 diabetes. Supporting income mobility and minimizing financial hardship could be pivotal steps in reducing the burden of severe hypoglycemia and improving overall diabetes care," the authors concluded.
Reference:
Kim M, Han K, Lee K, et al. Income and Severe Hypoglycemia in Type 2 Diabetes. JAMA Netw Open. 2025;8(6):e2513293. doi:10.1001/jamanetworkopen.2025.13293
