Self reported hypoglycemia in patients with type 2 diabetes mellitus taking oral anti-diabetics

Abstract

Objective

To determine the proportion of patients of type 2 Diabetes taking oral antidiabetics with self reported hypoglycemia and its causes.

Background

Hypoglycemia, an acute complication of diabetes mellitus is not only responsible for recurrent morbidity but also can lead to permanent brain damage or fatality if not recognized and treated in time. Also, hypoglycemia prevents achieving glycemic targets in diabetic patients.

Methods

Cross-sectional observation study of 70 patients of type 2 diabetes on oral anti-diabetics was conducted at Lok Nayak Hospital to determine the proportion of patients with self reported hypoglycemia and also to find out the various causes of hypoglycemia by subjecting them to a structured questionnaire. Hypoglycemia was considered when patient experienced at least one symptom, at least 2–3 times in last one month and symptom(s) were relieved by consuming sugar/meal.

Results

38.6% of the study subjects had hypoglycemia, out of which 92.59% patients had symptomatic hypoglycemia. Out of the patients experiencing hypoglycemia, 32% had severe episodes, 12% visited the hospital and 48% had more than 5 episodes per month. Dizziness was the commonest reported symptom (64%), followed by palpitations (52%). Attributed causes of hypoglycemia were missing meal (64%), drugs other than oral anti-diabetics (44%), sulfonylureas (44.2% in patients taking vs. 26.9% in patients not taking sulfonylurea), comorbidities (41% with vs. 22.4% without comorbidities) and lower socioeconomic status. One-third of patients experiencing were checking blood glucose levels during the symptoms. Highest prevalence of hypoglycemia was seen with HbA_1c < 6.5% (p-value 0.04 when compared with subjects with HbA_1c ≥ 6.5%), followed by ≥ 8% and least in 6.5–7.9%.

Conclusions

Lower prevalence of hypoglycemia in our study compared to other similar studies could be because of non-inclusion of patients on insulin in our study. High prevalence of multiple episodes justify the fact that hypoglycemia begets hypoglycemia. Hypoglycemia progressively increased as socioeconomic status changed from higher to lower, possibly due to non-availability of glucometer and lack of information. U-shaped correlation of hypoglycemic events was found with HbA_1c levels.