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Risk factors of severe hypoglycemia requiring medical assistance and neurological sequelae in patients with diabetes

View Article: PubMed Central - PubMed

ABSTRACT

Hypoglycemia commonly occurs in patients who are being treated for diabetes. In some cases, these patients suffer from severe hypoglycemia that requires medical assistance and which can unfortunately result in long-term disabilities. Therefore, we investigated risk factors associated with severe hypoglycemia requiring medical assistance (HMA) and the resulting neurological sequelae in patients with diabetes. This investigation was a case–control study that assessed 129 patients with diabetes and documented hypoglycemia from a single tertiary hospital between February 2013 and May 2015. They were treated with oral hypoglycemic agents alone (54%) or with insulin with/without oral hypoglycemic agents (46%). If a patient with diabetes visited the emergency department due to hypoglycemia, this was defined as HMA. The control group was composed of patients with documented, nonsevere hypoglycemia who visited the outpatient clinic during the same period. The degree of neurological disability in the HMA patients was measured using the modified Rankin Scale. A multivariate analysis revealed that independent risk factors of HMA were associated with a lack of the self-monitoring of blood glucose (SMBG) and previous episodes of severe hypoglycemia. In the HMA group, 15 patients (22%) had neurological sequelae at the time of discharge. Patients with neurological sequelae were older than those without sequelae (74.3 years vs 65.8 years, P = 0.006) and had increased psychological evidence of disorders such as insomnia, dementia, and depression (40% vs 11%, P = 0.017). Patients with sequelae were also more likely to live in rural areas (47% vs 19%, P = 0.04) and to have a longer time from last seen normal till glucose administration (5.2 hours vs 1.6 hours, P = 0.027). In the present study, absence of SMBG and previous severe hypoglycemic episodes were independent risk factors of HMA and patients with an older age, a psychological disorder, a rural residence, and a prolonged duration of hypoglycemia had higher risks of neurological sequelae. Therefore, the present findings suggest that physicians should aim to prevent hypoglycemia in patients with a history of hypoglycemia and provide education for these patients regarding regular SMBG.

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Related in: MedlinePlus

Receiver operating characteristic curves of models for predicting severe hypoglycemia requiring medical assistance. P value = 0.006 between Model 1 and Model 2, SH = severe hypoglycemia, SMBG = self-monitoring of blood glucose.
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Figure 1: Receiver operating characteristic curves of models for predicting severe hypoglycemia requiring medical assistance. P value = 0.006 between Model 1 and Model 2, SH = severe hypoglycemia, SMBG = self-monitoring of blood glucose.

Mentions: Based on Model 2 from the multivariable logistic regression analysis, absence of SMBG and previous episodes of severe hypoglycemia were independent predictors of HMA (odds ratio [OR]: 4.43, 95% confidence interval [CI]: 1.30–15.1, P = 0.017; OR: 22.0, 95% CI: 6.05–80.0, P < 0.001, respectively; Table 2). In addition, compared to Model 1, Model 2 showed an increased area under the receiver operating characteristic curve (0.690 vs 0.868, 95% CI: 6.08–82.4, P = 0.006; Fig. 1) for prediction of HMA.


Risk factors of severe hypoglycemia requiring medical assistance and neurological sequelae in patients with diabetes
Receiver operating characteristic curves of models for predicting severe hypoglycemia requiring medical assistance. P value = 0.006 between Model 1 and Model 2, SH = severe hypoglycemia, SMBG = self-monitoring of blood glucose.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC5134865&req=5

Figure 1: Receiver operating characteristic curves of models for predicting severe hypoglycemia requiring medical assistance. P value = 0.006 between Model 1 and Model 2, SH = severe hypoglycemia, SMBG = self-monitoring of blood glucose.
Mentions: Based on Model 2 from the multivariable logistic regression analysis, absence of SMBG and previous episodes of severe hypoglycemia were independent predictors of HMA (odds ratio [OR]: 4.43, 95% confidence interval [CI]: 1.30–15.1, P = 0.017; OR: 22.0, 95% CI: 6.05–80.0, P < 0.001, respectively; Table 2). In addition, compared to Model 1, Model 2 showed an increased area under the receiver operating characteristic curve (0.690 vs 0.868, 95% CI: 6.08–82.4, P = 0.006; Fig. 1) for prediction of HMA.

View Article: PubMed Central - PubMed

ABSTRACT

Hypoglycemia commonly occurs in patients who are being treated for diabetes. In some cases, these patients suffer from severe hypoglycemia that requires medical assistance and which can unfortunately result in long-term disabilities. Therefore, we investigated risk factors associated with severe hypoglycemia requiring medical assistance (HMA) and the resulting neurological sequelae in patients with diabetes. This investigation was a case&ndash;control study that assessed 129 patients with diabetes and documented hypoglycemia from a single tertiary hospital between February 2013 and May 2015. They were treated with oral hypoglycemic agents alone (54%) or with insulin with/without oral hypoglycemic agents (46%). If a patient with diabetes visited the emergency department due to hypoglycemia, this was defined as HMA. The control group was composed of patients with documented, nonsevere hypoglycemia who visited the outpatient clinic during the same period. The degree of neurological disability in the HMA patients was measured using the modified Rankin Scale. A multivariate analysis revealed that independent risk factors of HMA were associated with a lack of the self-monitoring of blood glucose (SMBG) and previous episodes of severe hypoglycemia. In the HMA group, 15 patients (22%) had neurological sequelae at the time of discharge. Patients with neurological sequelae were older than those without sequelae (74.3 years vs 65.8 years, P&#8202;=&#8202;0.006) and had increased psychological evidence of disorders such as insomnia, dementia, and depression (40% vs 11%, P&#8202;=&#8202;0.017). Patients with sequelae were also more likely to live in rural areas (47% vs 19%, P&#8202;=&#8202;0.04) and to have a longer time from last seen normal till glucose administration (5.2&#8202;hours vs 1.6&#8202;hours, P&#8202;=&#8202;0.027). In the present study, absence of SMBG and previous severe hypoglycemic episodes were independent risk factors of HMA and patients with an older age, a psychological disorder, a rural residence, and a prolonged duration of hypoglycemia had higher risks of neurological sequelae. Therefore, the present findings suggest that physicians should aim to prevent hypoglycemia in patients with a history of hypoglycemia and provide education for these patients regarding regular SMBG.

No MeSH data available.


Related in: MedlinePlus