Analysis of Hypoglycemic Episodes in Out Patient Diabetic in Africans Using Ademolus Classification of Hypoglycemia

Abstract

The recent grading of severity of hypoglycemia for use in clinical practice using Ademolus Classification of Hypoglycemia (ACH) is opening a new knowledge path and insight in hypoglycemia complicating diabetes mellitus management. In Africa like other parts of the world, hypoglycemia complicates diabetes mellitus management in in and out-patients. This article aims to examine hypoglycemia occurring in African diabetics on out patient pharmacologic management. This is a retrospective study of 200 hypoglycemic episodes occurring in 88 diabetics attending the out patients of the Endocrinology Clinic of Lagos State University Teaching Hospital, Lagos, Nigeria. Over 13years and 9 months period. Data were analysed using ADEMOLUS CLASSIFICATION OF HYPOGLYCEMIA and American Diabetes Association (ADA)/European Association for the Study of Diabetes (EASD) 2018 Classification of Hypoglycemia. Only documented hypoglycemic episodes were studied using a questionnaire. The inclusion criteria includes known diabetics, documented hypoglycemic episodes occurring during out patient pharmacologic management. This study was analysed using SPSS version 17. Of the 200 hypoglycemic episodes studied, 79.5% were grade 1, grade 2 were 18% while 2.5% were grade 3. In all type 2 diabetics (T2DM), 82.9% had grade 1 hypoglycemia, 14.6% had grade 2, while 2.4% had grade 3. The lowest hypoglycemic episode among out patient T2DM was an asymptomatic value of 29mg/dl (grade 3 hypoglycemia!). There is an inverse relationship between hypoglycemic episodes recorded in type 1 and type 2 diabetics as the pearson correlation was -1.000. This denotes a perfect negative correlation between hypoglycemic episodes developed in type 1 compared to type 2 diabetics in Africans. There is no linear relationship between these two variables. With a p-value of 0.000, the null hypothesis is discarded in this study as these findings is not due to chance or error of sampling but rather are statistically significant. ADA/EASD 2018 classification of hypoglycemia is not very sensitive in diagnosing severe hypoglycemia in that it recognized only 1 hypoglycemic episodes while ACH recognizes five. The five cases all have blood sugar of less than 40mg/dl yet ADA/EASD 2018 classification recognizes only one because it developed a severe event from hypoglycemia needing assistance from a third party. The majority of T2DM had mild hypoglycemic episodes irrespective of whether they are on oral hypoglycemic agents (OHA) alone, or on OHA and insulin or on insulin alone. Among African T1DM, grade 1 hypoglycemia is twice as common as grade 2 hypoglycemia while severe hypoglycemia is not common. Grades 1, 2 and 3 hypoglycemia can all occur in African diabetics on out patients basis but with the majority occurring as grade 1. Asymptomatic grade 3 hypoglycemia can occur in out patient African T2DM. A similar study is advised in other regions of the world.