Clinical Characteristics and Hospitalisation Outcomes of Hypoglycaemia in Hospitalised Patients With Type 2 Diabetes Mellitus
Abstract
Background/Aim: Strict glycaemic control delays the onset as well the progression of diabetes related microvascular complications. The major roadblock in achieving the target glycated haemoglobin (HbA1c) and blood glucose levels is hypoglycaemia. The aim of this study was to assess the clinical characteristics and outcomes of hypoglycaemia in the type 2 diabetes mellitus (T2DM) hospitalised patients.
Methods: This was an observational study done for nine months in T2DM patients who had documented hypoglycaemia (blood glucose < 70 mg/dL) during the hospital stay. T2DM patients with hypoglycaemia on admission, hypoglycaemia due to anti-diabetic drug overdose, intensive care unit (ICU) patients with hypoglycaemia were excluded from the study. Eligible patients were categorised into two groups as symptomatic and asymptomatic hypoglycaemia. Clinical features, risk factors, hospitalisation outcome were compared between the symptomatic and asymptomatic hypoglycaemia group.
Results: Two hundred patients were enrolled in this study (n = 89, symptomatic group and n = 111, asymptomatic hypoglycaemia). Hypoglycaemic episode in past was significantly associated with symptomatic hypoglycaemic events during hospitalisation [34 (38.2 %) vs 27(24.3 %)], p = 0.01. Admission blood glucose levels (mg/dL), HbA1c (%) were significantly higher in symptomatic hypoglycaemia group [(225.93 vs 178.72, p = 0.008), (8.55 ± 2.49 vs 7.72 ± 1.82, p = 0.007)], respectively. The blood glucose level during the hypoglycaemia episode was significantly higher in patients with asymptomatic hypoglycaemia group (56.38 ± 9.51 vs 44.22 ± 11.21 mg/dL, p < 0.001). Patients with HbA1c ≤ 6 % were significantly higher in asymptomatic hypoglycaemia (n = 12, 10.8 % vs n = 2, 2.24 %, p = 0.02). Majority recovered fully without complications and got discharged (n = 155, 77.5 %).
Conclusion: In presented study, symptomatic hypoglycaemic patients had significantly higher admission blood glucose levels and HbA1c %. Patients with HbA1c < 6 % were significantly higher in asymptomatic group. Past history of hypoglycaemia was significantly associated with symptomatic hypoglycaemia during hospitalisation.
References
UK Prospective Diabetes Study (UKPDS) Group: Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). Lancet. 1998;352(9131):837-53. doi: 10.1016/S0140-6736(98)07019-6.
Nathan DM, Genuth S, Lachin J, Cleary P, Crofford O, Davis M, et al. The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus (Diabetes Control and Complications Trial Research Group). N Engl J Med. 1993;329:977-86. doi:10.1056/NEJM199309303291401.
Viswanathan M, Joshi SR, Bhansali A. Hypoglycemia in type 2 diabetes: Standpoint of an experts' committee (India hypoglycemia study group). Indian J Endocrinol Metab. 2012;16(6):894-8. doi:10.4103/2230-8210.102986.
Heller SR, Peyrot M, Oates SK, Taylor AD. Hypoglycemia in patient with type 2 diabetes treated with insulin: it can happen. BMJ Open Diabetes Res Care. 2020;8(1):e001194. doi:10.1136/bmjdrc-2020-001194.
Zammitt NN, Frier BM. Hypoglycemia in type 2 diabetes: pathophysiology, frequency, and effects of different treatment modalities. Diabetes Care. 2005;28:2948-61. doi:10.2337/diacare.28.12.2948.
Cryer PE: The barrier of hypoglycemia in diabetes. Diabetes. 2008;57:3169-76. doi:10.2337/db08-1084.
Olujide OP, Olujide ME, Leonardi-Bee J, Chattopadhyay K. Content and quality of clinical practice guidelines for the management of type 2 diabetes in India: A systematic review. Endocrinol Diabetes Metab. 2023;6:405. doi:10.1002/edm2.405.
Maiti S, Akhtar S, Upadhyay AK, Mohanty SK. Socioeconomic inequality in awareness, treatment and control of diabetes among adults in India: Evidence from National Family Health Survey of India (NFHS), 2019-2021. Sci Rep. 2023;13(1):2971. doi:10.1038/s41598-023-29978-y.
Chopra S, Kewal A. Does hypoglycemia cause cardiovascular events? Indian J Endocrinol Metab. 2012;16:102-4. doi: 10.4103/2230-8210.91203.
Cruz P. Inpatient hypoglycemia: the challenge remains. J Diabetes Sci Technol. 2020;14(3):560-6. doi: 10.1177/1932296820918540.
Seaquist ER, Anderson J, Childs B, Cryer P, Dagogo-Jack S, Fish L, et al; American Diabetes Association; Endocrine Society. Hypoglycemia and diabetes: a report of a workgroup of the American Diabetes Association and the Endocrine Society. J Clin Endocrinol Metab. 2013 May;98(5):1845-59. doi: 10.1210/jc.2012-4127.
Segel SA, Paramore DS, Cryer PE. Hypoglycemia-associated autonomic failure in advanced type 2 diabetes. Diabetes. 2002;51:724-33. doi:10.2337/diabetes.51.3.724.
Brown AF, Mangione CM, Saliba D, Sarkisian CA; California Healthcare Foundation/American Geriatrics Society Panel on Improving Care for Elders with Diabetes. Guidelines for improving the care of the older person with diabetes mellitus. J Am Geriatr Soc. 2003 May;51(5 Suppl Guidelines):S265-80. doi: 10.1046/j.1532-5415.51.5s.1.x.
Criner KE, Kim HN, Ali H, Kumar SJ, Kanter JE, Wang L, et al. Hypoglycemia symptoms are reduced in hospitalized patients with diabetes. J Diabetes Complications. 2021;35:107976. doi: 10.1016/j.jdiacomp.2021.107976.
American Diabetes Association. Standards of medical care in diabetes-2020 abridged for primary care providers. Clin Diabetes. 2020;38(1):10-38. doi:10.2337/cd20-as01.
Shriraam V, Mahadevan S, Anitharani M, Jagadeesh NS, Kurup SB, Vidya TA, et al. Reported hypoglycemia in Type 2 diabetes mellitus patients: Prevalence and practices-a hospital-based study. Indian J Endocrinol Metab. 2017;21(1):148-53. doi: 10.4103/2230-8210.196002.
Silbert R, Salcido-Montenegro A, Rodriguez-Gutierrez R, Katabi A, McCoy RG. Hypoglycemia among patients with type 2 diabetes: epidemiology, risk factors, and prevention strategies. Curr Diab Rep. 2018;18(8):53. doi: 10.1007/s11892-018-1018-0.
Lipska KJ, Warton EM, Huang ES, Moffet HH, Inzucchi SE, Krumholz HM, et al. HbA1c and risk of severe hypoglycemia in type 2 diabetes: the Diabetes and Aging Study. Diabetes Care. 2013 Nov;36(11):3535-42. doi: 10.2337/dc13-0610.
Davis TM, Brown SG, Jacobs IG, Bulsara M, Bruce DG, Davis WA. Determinants of severe hypoglycemia complicating type 2 diabetes: the Fremantle Diabetes Study. J Clin Endocrinol Metab. 2010;95:2240-7. doi:10.1210/jc.2009-2828.
Kang MY. Blood electrolyte disturbances during severe hypoglycemia in Korean patients with type 2 diabetes. Korean J Intern Med. 2015, 30:648-56. doi: 10.3904/kjim.2015.30.5.648.
Carreira A, Castro P, Mira F, Melo M, Ribeiro P, Santos L. Acute kidney injury: a strong risk factor for hypoglycaemia in hospitalized patients with type 2 diabetes. Acta Diabetol. 2023;60(9):1179-85. doi:10.1007/s00592-023-02112-0.
Saito N, Toyoda M, Ono M, Kaneyama N, Kimura M, Fukagawa M. Importance of the evaluation of renal function for the prevention of hypoglycemia in elderly diabetes patients. Tokai J Exp Clin Med. 2020;45(3):139-43. http://mj-med-u-tokai.com/pdf/450309.pdf.
ACCORD Study Group; Buse JB, Bigger JT, Byington RP, Cooper LS, Cushman WC, Friedewald WT, et al. Action to control cardiovascular risk in diabetes (ACCORD) trial: design and methods. Am J Cardiol. 2007 Jun 18;99(12A):21i-33i. doi: 10.1016/j.amjcard.2007.03.003.
Zoungas S, Patel A, Chalmers J, de Galan BE, Li Q, Billot L, et al; ADVANCE Collaborative Group. Severe hypoglycemia and risks of vascular events and death. N Engl J Med. 2010 Oct 7;363(15):1410-8. doi: 10.1056/NEJMoa1003795.
- Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
- Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
- Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work (See The Effect of Open Access).