Endocrine Abstracts

Background: Diabetes mellitus is an emerging global epidemic and is the main illness threatening human health in 21st century. The target clinical outcomes in patients with type 2 diabetes mellitus (T2DM) is good control of HbA1C less than 7 %. However, aggressive treatment is needed to achieve this target in some patients. But this aggressive treatment predisposes patients to a higher risk of hypoglycemia that become a major hurdle in achieving glycemic goal in these patients. Hypoglycemia is one of most feared complication of diabetes treatment and the very important barrier in achieving tight glycemic control in diabetes patients.

Objective: To describe characteristics of the patients with T2DM presenting with hypoglycemia and identify the predisposing factors of hypoglycemia in them.

Materials and Methods: This cross-sectional study was conducted in a hospital in rural India from January 2021 to November 2021. Venous plasma glucose was measured in all patients with T2DM presented with signs-symptoms of hypoglycemia, patients having biochemically confirmed hypoglycemia (venous plasma glucose <70 mg/dl) were selected for the study. Proper history was taken from patients and their relatives to obtain the demographic and clinical data including hypoglycemic symptoms.

Results: Fourty three with T2DM were included in the study among whom 60% were female, 56% aged ≥60 years, 90% lived in rural and sub-urban areas, 52% had diabetes for ≥10 years, and 25% took insulin. Hypertension was the most common (55%) co-morbid condition followed by ischemic heart disease (23%) and CKD (13%).28% patients presented in unconscious state. Their mean plasma glucose at presentation was 51 mg/dl. Skipped meal was the most common precipitating factor followed by drug overdose and other medical illness such as CKD. More than half had (51%) hypoglycemic episodes in the preceding 12 months. Self-monitoring of blood glucose (SMBG) was done in only 7% patients.

Conclusions: Hypoglycemia is the most common and often treatment-limiting serious adverse effect of diabetes therapy. Despite being potentially preventable, hypoglycemia in type 2 diabetes incurs substantial personal and societal burden. Awareness of hypoglycemia and its timely management at home needs to be emphasized. Patient education regarding hypoglycemic signs and symptoms, regular meal timings, proper exercise, regular follow ups and self-monitoring of blood glucose (SMBG) and sick days care are of utmost importance to prevent hypoglycemia.