Send to

Choose Destination
Can J Diabetes. 2014 Feb;38(1):45-52. doi: 10.1016/j.jcjd.2013.09.001.

The effect of hypoglycemia on health-related quality of life: Canadian results from a multinational time trade-off survey.

Author information

Department of Family Medicine, Western University, London, Ontario, Canada. Electronic address:
Applied Health Research Centre (AHRC), Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Ontario, Canada; Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada; Institute of Health Policy, Management, and Evaluation and Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada.
Incentive Partners, Holte, Denmark.
Novo Nordisk A/S, Søborg, Denmark.
Novo Nordisk Canada Inc, Mississauga, Ontario, Canada.



The aim of this study was to investigate the impact of hypoglycemia according to severity and time of onset on health-related quality of life (HRQoL) in a Canadian population.


Time trade-off (TTO) methodology was used to estimate health utilities associated with hypoglycemic events in a representative sample of the Canadian population. A global analysis conducted in the United Kingdom, Canada, Germany and Sweden has been published. The present Canadian analysis focuses on 3 populations: general, type 1 and type 2 diabetes. Using a web-based survey, participants (>18 years) assessed the utility of 13 different health states (severe, non-severe, daytime and nocturnal hypoglycemia at different frequencies) using a scale from 1 (perfect health) to 0 (death). The average disutility value for each type of event was calculated.


Of 2258 participants, 1696 completers were included in the analysis. A non-severe nocturnal hypoglycemic event was associated with a significantly greater disutility than a non-severe daytime event (-0.0076 vs. -0.0056, respectively; p=0.05), while there was no statistically significant difference between severe nocturnal and severe daytime events (-0.0616 vs. -0.0592; p=0.76). Severe hypoglycemia was associated with greater disutility than non-severe hypoglycemia (p<0.0001). Similar trends were reported in participants with diabetes.


The findings presented here show that any form of hypoglycemia had a negative impact on HRQoL in a Canadian population. Nocturnal and/or severe hypoglycemia had a greater negative impact on HRQoL compared with daytime and/or non-severe events. This highlights the importance of preventing the development and nocturnal manifestation of hypoglycemia in patients with diabetes.


Canada; diabetes mellitus; diabète sucré; hypoglycemia; hypoglycémie; quality of life; qualité de vie; théorie de l’utilité; utility theory

[Indexed for MEDLINE]
Free full text

Supplemental Content

Full text links

Icon for Elsevier Science
Loading ...
Support Center