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Survey of Hypoglycemia in Elderly People With Type 2 Diabetes Mellitus in Japan.

Fukuda M, Doi K, Sugawara M, Naka Y, Mochizuki K - J Clin Med Res (2015)

Bottom Line: Targeted elderly T2DM outpatients were 65 years old or older in 2011.Specialized questionnaire survey forms were distributed to both of physicians and patients.The most common symptom was "weakness, fatigue/feeling languid" and the majority of all patients reported neuroglycopenic or autonomic symptoms.

View Article: PubMed Central - PubMed

Affiliation: Fukuda Clinic, 2F Shin Osaka Brick Building, 1-6-1 Miyahara, Yodogawa-ku, Osaka-shi, Osaka 532-0003, Japan ; Member of the Japan Physicians Association.

ABSTRACT

Background: The number of elderly type 2 diabetes mellitus (T2DM) patients in Japan is increasing continuously. Hypoglycemia is a significant issue in their treatment. However, the actual situation and related details of their hypoglycemia remain unclear. In order to elucidate them, the Japan Physicians Association conducted a large-scale questionnaire survey for physicians and their outpatients all over Japan.

Methods: Targeted elderly T2DM outpatients were 65 years old or older in 2011. Specialized questionnaire survey forms were distributed to both of physicians and patients. The forms for physicians included questions whether patient had hypoglycemia in the last 1 month or 1 year; those for patients included whether they experienced it in the same durations and any of the 28 symptoms that are suggestive of hypoglycemia or pertaining to geriatric syndrome in the last 1 month, as well as questions about knowledge regarding hypoglycemia. We analyzed associations between hypoglycemia and the symptoms, and between hypoglycemia and medications.

Results: Of 15,892 T2DM patients (age, 74.2 ± 6.3 years; diabetes duration, 12.8 ± 8.9 years; HbA1c, 7.0±1.0%), dipeptidyl peptidase-4 inhibitor (DPP-4i) was the most prescribed medication among all oral hypoglycemic agents (OHAs). The frequencies of hypoglycemia in the last 1 month recognized by physicians and experienced by patients were 7.8% and 10.4% (P < 0.0001), and in the last 1 year were 15.5% and 21.1% respectively (P < 0.0001). The most common symptom was "weakness, fatigue/feeling languid" and the majority of all patients reported neuroglycopenic or autonomic symptoms. Regarding monotherapy, hypoglycemia was observed in 32.7% of the patients with insulin, 4% in sulfonylurea (SU), 3.8% in glinide, and 3.5% in pioglitazone. The questions asking knowledge about hypoglycemia revealed that SU or insulin users had significantly more knowledge of hypoglycemia than others (P < 0.001); however, 63% of patients using insulin, and 31% of patients using SU always carried glucose or a similar medication with them.

Conclusions: The present study suggested two types of "hidden hypoglycemia", one is that physicians did not detect and the other one is that patients were not aware. It is vital that physicians strive to prevent hypoglycemia by paying closer attention to symptoms of "hidden hypoglycemia" in their elderly patients.

No MeSH data available.


Related in: MedlinePlus

Hypoglycemia in patients with the 28 symptoms. Patients with hypoglycemia commonly presented with weakness, fatigue/feeling languid, dizziness/lightheadedness, cognitive dysfunction/forgetfulness, back pain, and frequent urination, and cold sweats. *P < 0.05, **P < 0.01, ***P < 0.001.
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Figure 4: Hypoglycemia in patients with the 28 symptoms. Patients with hypoglycemia commonly presented with weakness, fatigue/feeling languid, dizziness/lightheadedness, cognitive dysfunction/forgetfulness, back pain, and frequent urination, and cold sweats. *P < 0.05, **P < 0.01, ***P < 0.001.

Mentions: Regarding symptoms experienced subjectively by patients in the last 1 month, Figure 4 shows results with patients divided into groups according to whether they answered that they did or did not experience hypoglycemia. The most common symptom, “weakness, fatigue/feeling languid,” was noted in 32.7% patients in the hypoglycemia group, whereas it was noted only in 15.0% patients in the non-hypoglycemia group. Furthermore, in the hypoglycemia and non-hypoglycemia groups, “dizziness/lightheadedness” was experienced by 32.4% vs. 13.1%, respectively, followed by “cognitive dysfunction/forgetfulness” by 30.6% vs. 26.3%, “back pain” by 30.6% vs. 25.7%, “frequent urination” by 30.6% vs. 27.4%, and “cold sweat” by 30.1% vs. 3.9%, respectively. Thus, neuroglycopenic symptoms such as “weakness, fatigue/feeling languid,” “dizziness/lightheadedness,” and “cognitive dysfunction/forgetfulness” were most common, whereas among the six most experienced symptoms, “cold sweat” was the only autonomic symptom noted.


Survey of Hypoglycemia in Elderly People With Type 2 Diabetes Mellitus in Japan.

Fukuda M, Doi K, Sugawara M, Naka Y, Mochizuki K - J Clin Med Res (2015)

Hypoglycemia in patients with the 28 symptoms. Patients with hypoglycemia commonly presented with weakness, fatigue/feeling languid, dizziness/lightheadedness, cognitive dysfunction/forgetfulness, back pain, and frequent urination, and cold sweats. *P < 0.05, **P < 0.01, ***P < 0.001.
© Copyright Policy - open access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4625818&req=5

Figure 4: Hypoglycemia in patients with the 28 symptoms. Patients with hypoglycemia commonly presented with weakness, fatigue/feeling languid, dizziness/lightheadedness, cognitive dysfunction/forgetfulness, back pain, and frequent urination, and cold sweats. *P < 0.05, **P < 0.01, ***P < 0.001.
Mentions: Regarding symptoms experienced subjectively by patients in the last 1 month, Figure 4 shows results with patients divided into groups according to whether they answered that they did or did not experience hypoglycemia. The most common symptom, “weakness, fatigue/feeling languid,” was noted in 32.7% patients in the hypoglycemia group, whereas it was noted only in 15.0% patients in the non-hypoglycemia group. Furthermore, in the hypoglycemia and non-hypoglycemia groups, “dizziness/lightheadedness” was experienced by 32.4% vs. 13.1%, respectively, followed by “cognitive dysfunction/forgetfulness” by 30.6% vs. 26.3%, “back pain” by 30.6% vs. 25.7%, “frequent urination” by 30.6% vs. 27.4%, and “cold sweat” by 30.1% vs. 3.9%, respectively. Thus, neuroglycopenic symptoms such as “weakness, fatigue/feeling languid,” “dizziness/lightheadedness,” and “cognitive dysfunction/forgetfulness” were most common, whereas among the six most experienced symptoms, “cold sweat” was the only autonomic symptom noted.

Bottom Line: Targeted elderly T2DM outpatients were 65 years old or older in 2011.Specialized questionnaire survey forms were distributed to both of physicians and patients.The most common symptom was "weakness, fatigue/feeling languid" and the majority of all patients reported neuroglycopenic or autonomic symptoms.

View Article: PubMed Central - PubMed

Affiliation: Fukuda Clinic, 2F Shin Osaka Brick Building, 1-6-1 Miyahara, Yodogawa-ku, Osaka-shi, Osaka 532-0003, Japan ; Member of the Japan Physicians Association.

ABSTRACT

Background: The number of elderly type 2 diabetes mellitus (T2DM) patients in Japan is increasing continuously. Hypoglycemia is a significant issue in their treatment. However, the actual situation and related details of their hypoglycemia remain unclear. In order to elucidate them, the Japan Physicians Association conducted a large-scale questionnaire survey for physicians and their outpatients all over Japan.

Methods: Targeted elderly T2DM outpatients were 65 years old or older in 2011. Specialized questionnaire survey forms were distributed to both of physicians and patients. The forms for physicians included questions whether patient had hypoglycemia in the last 1 month or 1 year; those for patients included whether they experienced it in the same durations and any of the 28 symptoms that are suggestive of hypoglycemia or pertaining to geriatric syndrome in the last 1 month, as well as questions about knowledge regarding hypoglycemia. We analyzed associations between hypoglycemia and the symptoms, and between hypoglycemia and medications.

Results: Of 15,892 T2DM patients (age, 74.2 ± 6.3 years; diabetes duration, 12.8 ± 8.9 years; HbA1c, 7.0±1.0%), dipeptidyl peptidase-4 inhibitor (DPP-4i) was the most prescribed medication among all oral hypoglycemic agents (OHAs). The frequencies of hypoglycemia in the last 1 month recognized by physicians and experienced by patients were 7.8% and 10.4% (P < 0.0001), and in the last 1 year were 15.5% and 21.1% respectively (P < 0.0001). The most common symptom was "weakness, fatigue/feeling languid" and the majority of all patients reported neuroglycopenic or autonomic symptoms. Regarding monotherapy, hypoglycemia was observed in 32.7% of the patients with insulin, 4% in sulfonylurea (SU), 3.8% in glinide, and 3.5% in pioglitazone. The questions asking knowledge about hypoglycemia revealed that SU or insulin users had significantly more knowledge of hypoglycemia than others (P < 0.001); however, 63% of patients using insulin, and 31% of patients using SU always carried glucose or a similar medication with them.

Conclusions: The present study suggested two types of "hidden hypoglycemia", one is that physicians did not detect and the other one is that patients were not aware. It is vital that physicians strive to prevent hypoglycemia by paying closer attention to symptoms of "hidden hypoglycemia" in their elderly patients.

No MeSH data available.


Related in: MedlinePlus