Background and aims: Hypoglycemia is a common complication of diabetes treatment and its associated with poor outcomes. A link between severe hypoglycemia and renal dysfunction was suggested. No studies evaluated the impact of hypoglycemia of inpatients in microvascular or macrovascular complications. The aim of our work was to study the evolution of renal function between admission and final visit, and the impact of nephropathy in the presence of hypoglycemia in inpatients.
Materials and methods: Retrospective, observational study of consecutive patients with type 1 (n=13) and 2 Diabetes (n=85), admitted to the medical specialties ward between 2011 and 2015 (n=106 admissions), who had their capillary glycemia written in the medical record (n=14410). We evaluated the renal function (glomerular filtration rate determined by CKD-EPI formula; glicemic variability (STD) and albuminuria) at admission and at the final visit as outpatients. We used descriptive statistics (Median ± std), t-test and non-parametric tests for continuous variables and Chi-squared distribution for categorical variables.
Results: We report 56 admissions with hypoglycemias, which were compared to 50 admissions without hypoglicemias in the same period. There were no differences in the distribution of gender (64% were females), age (60.9±1.6 years), diabetes type (12.2% were type 1) or diabetes duration (5.0±1.0 years). In patiens with hypoglicemia we found significant differences in glicemic variability (84 vs 56 mg/dl, P<0.01), in GFRe at admission (94 vs 83 ml/min/1.73 m2, P=0.03), GFRe decline (25 vs 7 ml/min/1.73 m2, P=0.03), and longer hospital stay (13 vs 6 days, P=0.006).
Conclusion: Despite having the known limitations of a retrospective study, and some heterogenecity of the population mainly in diabetes duration, we found significant associations between occurrence of hypoglicemia during hospitalization and longer hospital stay and decline of renal function. Other study design would be required to investigate if it is only a marker of fragility or if hypoglycemia may have a role in progression of microvascular complications, as suggested by some investigators.
20 - 23 May 2017
European Society of Endocrinology