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Original Article
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Korean J Intern Med. 2026;41(5):916-926. Published online September 1, 2026.
DOI: https://doi.org/10.3904/kjim.2026.084
- Diabetes progression and severe hypoglycemia: a nationwide cohort study of 2,475,605 adults with type 2 diabetes mellitus
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Kyu-Na Lee1, Bongseong Kim2, Mee Kyoung Kim3
, Sukil Kim1
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1Department of Preventive Medicine and Public Health, College of Medicine, The Catholic University of Korea, Seoul, Korea
2Department of AI-Bio, Graduate School of AI, Soongsil University, Seoul, Korea
3Division of Endocrinology and Metabolism, Department of Internal Medicine, Eunpyeong St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
- Corresponding author: Mee Kyoung Kim ,Tel: +82-2-2030-4435, Fax: +82-2-595-2534, Email: makung@catholic.ac.kr
Sukil Kim ,Tel: +82-2-2258-7367, Fax: +82-2-532-6537, Email: sikimmd@catholic.ac.kr
- Received: February 20, 2026; Revised: April 22, 2026 Accepted: May 11, 2026.
- Abstract
- Background/Aims
Severe hypoglycemia (SH) is a major concern in type 2 diabetes mellitus (T2DM). We evaluated whether a composite diabetes progression score could predict incident SH.
Methods
Using the Korean National Health Insurance Service database, we identified 2,475,605 adults with T2DM who underwent health examinations in 2015−2016. Incident SH was defined by ICD−10 codes plus emergency department visit or hospitalization. The progression score (range, 0−6) comprised six indicators: longer diabetes duration, use of ≥ 3 oral glucose-lowering drug classes, insulin use, chronic kidney disease (CKD), cardiovascular disease, and diabetic retinopathy.
Results
During 1 year of follow-up, 1,186 SH events occurred. Each component of diabetes progression was independently insuassociated with SH risk hazard ratios (HRs) from 1.19–3.27, with insulin use and CKD showing the largest effects. SH risk increased stepwise with higher progression scores. Compared with a score of 0, the adjusted HRs (95% confidence intervals) were 3.35 (2.63−4.27), 7.74 (6.15−9.74), 12.61 (9.97−15.95), 22.39 (17.44−28.75) for scores 1, 2, 3, and ≥ 4, respectively.
Conclusions
A concise diabetes progression score strongly stratified short-term SH risk in this nationwide cohort, and may help target proactive prevention and early intervention.
Keywords :Diabetes mellitus, Type 2; Hypoglycemia; Disease progression
