Response to Comment on: Holstein et al. Substantial Increase in Incidence of Severe Hypoglycemia Between 1997-2000 and 2007-2010: A German Longitudinal Population-Based Study. Diabetes Care 2012;35:972-975

We thank Kerner and Volzke (1) for their interest in our study. It is correct that such population-based studies are extremely difficult to perform and need to be interpreted with caution. However, the authors neglect several crucial premises in interpreting data on frequency of severe hypoglycemia (SH).In the cited studies from Scotland (2), Australia (3), and Germany (4,5) definitions of SH, methods of data collection, and differences in healthcare systems considerably skew the comparison. Our study, in contrast, used a precise and restrictive definition of SH as a symptomatic event requiring treatment with intravenous glucose and being confirmed by a blood glucose measurement of <50 mg/dL. Performing …