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Abstract
Background
Hypoglycemia is an important obstacle in the treatment of diabetes. When diabetic patients experience hypoglycemia, thorough glycemic control is more difficult. We evaluated the factors associated with risk of hypoglycemia and identified whether the demographic and clinical characteristics or the medication pattern changed during the study period.
Methods
This study was conducted retrospectively with 7 years of data from one university hospital emergency department. We evaluated the medical records of 396 diabetic patients who visited the emergency room with hypoglycemia between January 2008 and December 2014. Hypoglycemia was defined as a serum glucose level less than 70 mg/dL or an event requiring the assistance of another person to actively corrective action.
Results
The mean age, duration of diabetes, and hemoglobin A1c (HbA1c) of the study subjects were 71 ± 12.2 years, 12.7 ± 8.8 years, and 6.7 ± 1.39%, respectively. Among the subjects, 55% had a HbA1c level lower than 6.5%. Two-thirds of the study subjects received sulfonylurea, and one-third were treated with insulin. We observed a decreasing trend in the number of hypoglycemia cases during the study period. This trend might be partly explained by the decrease in sulfonylurea use and increase in dipeptidyl peptidase 4 inhibitor prescription during the study period.
References
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Fig. 2.
The number of outpatient prescriptions of hypoglycemic agents at Chuncheon Sacred Heart Hospital by year. DPP-4 inhibitor, dipeptidyl peptidase 4 inhibitor.
Fig. 3.
The number of outpatient insulin prescriptions at Chuncheon Sacred Heart Hospital by year. NPH, Neutral Protamine Hagedorn Insulin.
Table 1.
Characteristics of the enrolled diabetic hypoglycemic patients
Table 2.
Comparison of clinical characteristics according to the year of presentation with hypoglycemia
| Characteristic | 2008 | 2009 | 2010 | 2011 | 2012 | 2013 | 2014 |
|---|---|---|---|---|---|---|---|
| Patients | 49 (12.4) | 84 (21.2) | 62 (15.7) | 64 (16.2) | 57 (14.4) | 42 (10.6) | 38 (9.6) |
| Age (y) | 69.8 ± 8.9 | 70.7 ± 12.0 | 69.4 ± 12.4 | 70.9 ± 14.0 | 70.6 ± 14.0 | 75.0 ± 10.3 | 72.1 ± 11.3 |
| P-valuea | 0.615 | 0.52 | 0.932 | 0.943 | 0.053 | 0.555 | |
| Sex (male/female) | 27 (55.1) | 35 (41.7) | 28 (45.2) | 32 (50.0) | 20 (35.1) | 18 (42.9) | 23 (60.5) |
| /22 (44.9) | /49 (59.8) | /34 (54.8) | /32 (50.0) | /37 (64.0) | /24 (57.1) | /15 (39.5) | |
| P-valueb | 0.152 | 0.736 | 0.323 | 0.484 | > 0.99 | 0.078 | |
| Duration of diabetes mellitus (y) | 12.7 ± 8.4 | 11.9 ± 9.4 | 12.5 ± 8.7 | 14.3 ± 9.5 | 13.3 ± 9.1 | 11.9 ± 8.0 | 12.2 ± 6.9 |
| P-valuea | 0.613 | 0.714 | 0.141 | 0.393 | 0.977 | 0.89 | |
| Body mass index (kg/m2) | 21.9 ± 3.0 | 24.0 ± 3.9 | 24.2 ± 4.7 | 23.9 ± 3.7 | 23.4 ± 3.6 | 23.0 ± 3.7 | 24.3 ± 3.8 |
| P-valuea | 0.005 | 0.792 | 0.852 | 0.381 | 0.226 | 0.772 | |
| Smoking | 14 (28.6) | 15 (17.9) | 9 (14.5) | 8 (12.5) | 11 (19.3) | 7 (16.7) | 4 (10.5) |
| P-valueb | 0.192 | 0.656 | 0.243 | 0.131 | > 0.99 | 0.421 | |
| Alcohol | 11 (22.4) | 15 (17.9) | 6 (9.7) | 15 (23.4) | 10 (17.5) | 7 (16.7) | 11 (28.9) |
| P-valueb | 0.467 | 0.233 | 0.286 | 0.027 | >0.99 | 0.232 | |
| Hypertension | 40 (81.6) | 68 (81.0) | 48 (77.4) | 51 (79.7) | 44 (77.2) | 31 (73.8) | 28 (73.7) |
| P-valueb | > 0.99 | 0.68 | > 0.99 | 0.672 | 0.366 | 0.474 | |
| Dyslipidemia | 36 (73.5) | 63 (75.0) | 48 (77.4) | 51 (79.7) | 42 (73.7) | 31 (73.8) | 23 (60.5) |
| P-valueb | 0.84 | 0.845 | 0.558 | >0.99 | >0.99 | 0.2 | |
| Cardiovascular disease | 11 (22.4) | 15 (17.9) | 17 (27.4) | 14 (21.9) | 10 (17.5) | 9 (21.4) | 7 (18.4) |
| P-valueb | 0.651 | 0.224 | 0.676 | > 0.99 | 0.637 | > 0.99 | |
| Cerebrovascular disease | 12 (24.5) | 12 (14.3) | 9 (14.5) | 12 (18.8) | 8 (14.0) | 5 (11.9) | 10 (26.3) |
| P-valueb | 0.164 | > 0.99 | 0.505 | > 0.99 | 0.789 | 0.13 | |
| Stage 3∼5 chronic kidney disease | 16 (32.7) | 31 (36.9) | 21 (33.9) | 10 (15.6) | 13 (22.8) | 9 (21.4) | 12 (31.6) |
| P-valueb | 0.78 | 0.703 | 0.005 | 0.096 | 0.104 | 0.683 | |
| Cancer | 9 (18.4) | 17 (20.2) | 4 (6.5) | 7 (10.9) | 8 (14.0) | 5 (11.9) | 1 (2.6) |
| P-valueb | > 0.99 | 0.03 | 0.177 | 0.033 | 0.323 | 0.012 | |
| Hemoglobin A1c (%) | 6.6 ± 1.7 | 6.5 ± 0.9 | 7.2 ± 1.7 | 6.7 ± 1.3 | 6.9 ± 1.3 | 6.9 ± 1.7 | 6.3 ± 1.1 |
| P-valueb | 0.621 | 0.004 | 0.129 | 0.04 | 0.2799 | 0.348 | |
| Sulfonylurea user | 28 (57.1) | 55 (65.5) | 41 (66.1) | 40 (62.5) | 35 (61.4) | 32 (76.2) | 26 (68.4) |
| P-valueb | 0.359 | > 0.99 | 0.732 | 0.721 | 0.307 | 0.837 | |
| Insulin user | 19 (38.8) | 24 (28.6) | 22 (35.5) | 17 (26.5) | 17 (29.8) | 13 (31.0) | 13 (34.2) |
| P-valueb | 0.252 | 0.216 | > 0.99 | > 0.99 | 0.837 | 0.532 |
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