Hypoglycaemia among adults with Type 2 Diabetes mellitus in a Family Medicine Clinic
DOI:
https://doi.org/10.30442/ahr.0704-02-144Keywords:
Dipeptidylpeptidase-4 Inhibitors, Dyslipidaemia, Hypertension, Hypoglycaemia, Insulin, SulphonylureaAbstract
Background: The prevalence of Diabetes mellitus (DM) is increasing worldwide. The complications of DM arising from hyperglycaemia are well documented and. However, there is a lack of data, poor awareness and information on hypoglycaemia in DM.
Objective: To describe the prevalence and factors associated with hypoglycaemia among patients with Type 2 Diabetes mellitus (DM).
Methods: This was a retrospective study of the clinical records of patients with Type 2 DM at the Family Medicine Clinic of a Nigerian teaching hospital from January 2019 to January 2020. The sociodemographic and clinical characteristics, including hypoglycaemia, Glycosylated Haemoglobin (HbA1c), Fasting and Random blood glucose, were retrieved.
Results: A total number of 570 patients were assessed, with a prevalence of 43 (7.5%) of hypoglycaemia. The mean age of the patients in the study was 58.2±10.9 years (range: 36-83 years). Metformin (557; 97.7%), Sulphonylureas (377; 66.1%), Dipeptidylpeptidase -4 inhibitors (137; 24.0%) and insulin (72; 12.6%) were the most prescribed anti-diabetic medications. hypoglycaemiaA majority (29; 67.4%) of the hypoglycaemia episodes occurred in the morning, while most (24; 55.8%) of the episodes of hypoglycaemia were mild. Mean age (t= 2.35; p = 0.019), presence of hypertension (X2 = 6.92, p = 0.008) and dyslipidaemia (X2 = 7.86, p = 0.005) were associated with hypoglycaemia.
Conclusions: The prevalence of hypoglycaemia in the Outpatient clinic was low, while the presence of comorbidities (hypertension and dyslipidaemia) and age were associated with hypoglycaemia. There is a need for patient education and Self-Monitoring of Blood Glucose (SMBG) to prevent complications of hypoglycaemia. hypoglycaemia
References
International Diabetes Federation. IDF Diabetes Atlas, 9th Edition. Brussels, Belgium: 2019. Available at: http://www.diabetesatlas.org/ Accessed on 20 December 2020.
Parati G, Bilo G, Ochoa JE. Benefits of tight blood pressure control in diabetic patients with hypertension. Diabetes Care. 2011; 34: S297-S303.https://doi.org/10.2337/dc11-s243
Fullerton B, Jeitler K, Seitz M, Horvath K, Berghold A, Siebenhofer A. Intensive glucose control versus conventional glucose control for type 1 diabetes mellitus. Cochrane Database of Systematic Reviews 2014, Issue 2. Art. No.: CD009122. https://doi.org/10.1002/14651858.CD009122.pub2
Iloh GU, Amadi AN. Epidemiology of hypoglycaemia among ambulatory Type 2 diabetic patients in a primary care clinic of a tertiary hospital in Southeastern Nigeria. J Health Res Rev 2018; 5: 57-65. https://doi.org/10.4103/jhrr.jhrr_37_17
Birabwa C., Bwambale MF, Waiswa P. Quality and barriers of outpatient diabetes care in rural health facilities in Uganda – a mixed-methods study. BMC Health Serv Res .2019; 19: 706. https://doi.org/10.1186/s12913-019-4535-x
Ejegi A, Ross AJ, Naidoo K. Knowledge of symptoms and self-management of hypoglycaemia amongst patients attending a diabetic clinic at a regional hospital in KwaZulu-Natal. Afr J Pry Health Care Fam Med 2016; 8: e1-e6. https://doi.org/10.4102/phcfm.v8i1.906
Idowu AO, Adesegun OA, Osonuga A, Osibowale B, Ajiro T, Ngubor TD, et al. Patterns and Impact of Consultations to an Endocrinology Unit in a Tertiary Hospital in Southwestern Nigeria. Niger Med J 2018; 59: 28-32. https://doi.org/10.4103/nmj.NMJ_167_18
Abisoye OA, Oseribhor U. Prevalence and Presentation of Diabetes-Related Hypoglycaemia amongst Persons with Diabetes in a Tertiary Health Institution in Nigeria. Int J Diabetes Endocrinol. Special Issue: Hypoglycemia in Diabetes 2020; 5: 34-40. https://doi.org/10.11648/j.ijde.20200503.11
Besen BD, Arda Sürücü H, Kosar C. Self reported frequency, severity of, and awareness of hypoglycemia in type diabetes patients in Turkey. Peer J 2016; 4: e2700. https://doi.org/10.7717/peerj.2700
Patel A, MacMahon S, Chalmers J. Intensive blood glucose control and vascular outcomes in patients with type 2 diabetes. N Engl J Med 2008; 358: 2560-2572.
Duckworth W, Abraira C, Moritz T. VADT Investigators. Glucose control and vascular complications in veterans with type 2 diabetes. N Engl J Med 2009; 360: 129-139.
Gerstein HC, Miller ME. Action to Control Cardiovascular Risk in Diabetes Study Group. Effects of intensive glucose lowering in type 2 diabetes. N Engl J Med. 2008; 358: 2545-2559.
American Diabetes Association Workgroup on Hypoglycemia. Defining and Reporting Hypoglycemia in Diabetes: A report from the American Diabetes Association Workgroup of Hypoglycemia. Diabetes Care. 2005; 5: 1245-1249.
Ratzki-Leewing A, Harris SB, Mequanint S. Real-world crude incidence of hypoglycemia in adults with diabetes: Results of the In Hypo-DM Study, Canada. BMJ Open Diab Res Care 2018; 6: e000503. https://doi.org/10.1136/ bmjdrc-2017-000503
Leiter L, Yale J, Chiasson J. Assessment of the impact of fear of hypoglycemic episodes on glycemic and hypoglycemia management. Diabetes 2005; 29: 186–192.
International Hypoglycaemia Study Group: Glucose concentrations of less than 3.0 mmol/L (54 mg/dL) should be reported in clinical trials: a joint position statement of the American Diabetes Association and the European Association for the Study of Diabetes. Diabetes Care 2017; 40: 155–157. https://doi.org/10.2337/dc16-2215
Olamoyegun MA, Ayodele AO, Enikuomehin AC, Akinlade AT. Incidence and Determinants of Reported Hypoglycaemia among Patients with Type 2 Diabetes Mellitus in a Tertiary Health Institution in Nigeria. J Diabetes Mellitus 2020: 10; 51-63.
Schope D, Bramlage P, Binz C, Krekler M, Deeg E, Gitt AK. Incidence and predictors of hypoglycaemia in type 2 diabetes. An analysis of the prospective DiaRegis registry. BMC Endocr Disord 2012; 12: 23-30. https://doi.org/https://doi.org/10.1186/1472-6823-12-23
Samya V, Shriraam V, Jasmine A, et al. Prevalence of Hypoglycemia among patients with Type 2 Diabetes Mellitus in a Rural Health Center in South India. J Prim Care Community Health 2019; 10: 2150132719880638. https://doi.org/10.1177/2150132719880638
Quilliam BJ, Simeone JC, Ozbay AB, Kogut SJ. The incidence and costs of hypoglycemia in type 2 diabetes. Am J Manag Care. 2011; 17: 673-680.
Parsaik AK, Carter RE, Pattan V, Myers LA, Kumar H, Smith SA, et al. Population-based study of severe hypoglycemia requiring emergency medical service assistance reveals unique findings. J Diabetes Sci Technol 2012; 6: 65-73. https://doi.org/10.1177/193229681200600109
Hsu PF, Sung SH, Cheng HM, Yeh JS, Liu WL, Chan WL, et al. Association of clinical symptomatic hypoglycemia with cardiovascular events and total mortality in type 2 diabetes: a nationwide population-based study. Diabetes Care 2013; 36: 894-900. https://doi.org/10.2337/dc12-0916
Yang CM, Ma YL, Kang J , Jia Z, Wang YY. Time and department distribution of hypoglycemia occurrences in hospitalised diabetic patients. Int J Nurs Serv 2015: 9: 263-267. https://doi.org/10.1016/j.ijnss.2015.08.001
Shen LL, Zhang N. The situation analysis and nursing countermeasures of hypoglycaemia in hospitalised patients with diabetes. J Nurs 2012; 19(3A): 50e1. https://doi.org/10.1016/j.ijnss.2012.08.001
Ouyang SY, Wang QL, Wu XY. Hypoglycemia incidence survey hospitalised patients with diabetes. West China Med 2012; 27: 727e8.
Li DX, Song BY, Zhang LI, Ren L, Niu HY, Zhang H. 62 cases of type 2 diabetes patients in the intensive treatment characteristics analysis of hypoglycemia occurs. Chin J Nurs 2007; 42: 725e6.
Miller ME, Bonds DE, Gerslein HC, Seaquist ER, Bergenstal RM, Calles-Escandon J, et al. The effects of baseline characteristics, glycaemia treatment approach, and glycated haemoglobin concentration on the risk of severe hypoglycaemia: post hoc epidemiological analysis of the ACCORD study. BMJ 2010; 340: 5444. https://doi.org/10.1136/bmj.b5444
Wong MG, Petkovic V, Chalmers J, Woodward M, Li Q, Cooper ME, et al. Long-term benefits of intensive glucose control for preventing end-stage kidney disease: ADVANCE-ON. Diabetes Care 2016; 39: 694-700. https://doi.org/10.2337/dc15-2322
Agarwal AA, Jadhav PR, Deshmukh YA. Prescribing pattern and efficacy of anti-diabetic drugs in maintaining optimal glycemic levels in diabetic patients. J Basic Clin Pharm.2014; 5: 79-83. https://doi.org/10.4103/0976-0105.139731
Ademolu BA. Sulfonylureas Induced Hypoglycemia in Diabetics - A Review. Int J Diabetes Endocrinol Special Issue: Hypoglycemia in Diabetes. 2019;.4: 109-112. https://doi.org/10.11648/j.ijde.20190404.14
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: 148-153. https://doi.org/10.4103/2230-8210
Eriksson JW, Bodegard J, Nathanson D, Thuresson M, Nystro T, Norhammar A. Sulphonylurea compared to DPP-4 inhibitors in combination with metformin carries increased risk of severe hypoglycemia, cardiovascular events, and all-cause mortality. Diabetes Res Clin Pract.2016; 117: 39–4 7. https://doi.org/10.1016/j.diabres.2016.04.055
Signorovitch JE, Macaulay D, Diener M, Yan Y, Wu EQ, Gruenberger JB. Hypoglycaemia and accident risk in people with type 2 diabetes mellitus treated with non-insulin antidiabetes drugs. Diabetes Obes Metab 2013; 15: 335-341. https://doi.org/10.1111/dom.12031
Geller AI, Shehab N, Lovegrove MC, Kegler SR, Weidenbach KN, Ryan GJ, et al. National estimates of insulin-related hypoglycemia and errors leading to emergency department visits and hospitalisations. JAMA Intern Med 2014; 174: 678-686. https://doi.org/10.1001/jamainternmed.2014.136
Sami W, Ansari T, Butt NS, Hamid MRA. Effect of diet on type 2 diabetes mellitus: A review. Int J Health Sci 2017; 11: 65-67.
Downloads
Published
Issue
Section
License
The articles and other materials published in the Annals of Health Research are protected by the Nigerian Copyright laws. The journal owns the copyright over every article, scientific and intellectual materials published in it. However, the journal grants all authors, users and researchers access to the materials published in the journal with the permission to copy, use and distribute the materials contained therein only for academic, scientific and non-commercial purposes.