I am pleased that Kerner and Völzke (1) believe, based on their experience and assumptions, that the death rate from hypoglycemia in their patients with type 1 diabetes is lower than in the published literature. In my commentary (2) on the report of McCoy et al. (3) of a 3.4-fold higher mortality in patients with diabetes who self-reported severe hypoglycemia 5 years earlier, I cited four relatively recent series (all cited specifically in ref. 4) reporting that 4, 6, 7, and 10% of deaths of people with type 1 diabetes were attributed to hypoglycemia. Those proportions do not require any assumptions aside from the accuracy of the attributions. They are generally higher than the proportions of 2–4% of deaths reported in three earlier series (all also cited specifically in ref. 4), and are of even greater concern in view of the increasing life expectancy of individuals with type 1 diabetes (5). Given those published data—4% = 1 in 25 and 10% = 1 in 10—I concluded (2) that “it is sobering to think that as many as 1 in 25—or even 1 in 10—patients with type 1 diabetes will die of iatrogenic hypoglycemia. Obviously, life-threatening episodes of hypoglycemia need not be frequent to be devastating.” Whatever the precise hypoglycemic mortality rate, I think all who care for people with diabetes should consider these data (4).
Acknowledgments
P.E.C. has served as a consultant to Novo Nordisk in the past year. He does not receive research funds from, hold stock in, or speak for any pharmaceutical or device firm. No other potential conflicts of interest relevant to this article were reported.
