Clinical characteristics of patients with type 2 diabetes mellitus based on hypoglycemia frequency

Česká verzia

Authors: Michaela Plichtová; Emil Martinka
Authors place of work: Národný endokrinologický a diabetologický ústav, n. o., Ľubochňa
Published in the journal: Forum Diab 2020; 9(1): 13-21
Category:

Summary

Goal: By means of a retrospective cross-sectional study in the conditions of normal clinical practice, to give a statement on the clinical and laboratory characteristics of patients with DM2T with a more frequent IHG occurrence of iatrogenic hypoglycemia (IHG), and whether a more frequent occurrence is associated with an anamnesis of a more/less frequent occurrence of diabetes complications, atherosclerotic cardiovascular diseases and other selected comorbidities, including endocrinology (ENDO) and oncological (ONCO) diseases.

Cohort and methods: A retrospective cross-sectional study in the conditions of normal clinical practice in hospitalized patients with DM2T. The records of patient self-monitoring during the last month before hospitalization were used to evaluate a IH frequency. All the recorded glycemia values < 3.9 mmol/l were considered to be IH. Based on a IHG occurrence patients were divided into three subgroups: without recorded IHG (0IHG), with 1–2 recorded IHG (1–2IHG) and with three and more recorded IHG (> 3IHG). Clinical and laboratory parameters, incidence of diabetes related complications, CVD, ENDO, ONCO and other chronic comorbidities among the groups were compared, as well as those of antidiabetic, hypolipidemic, antihypertensive and antiplatelet and anticoagulant therapy. Data on patients was obtained from patient documentation and current examinations during hospitalization, within which a IHG occurrence within the initial 7 days of hospitalization was also evaluated based on standard 7-point glycemic profiles and glycemia testing any time during the day when required by the clinical situation.

Results: The study included 294 patients with DM2T. > 3IHG (n = 44) as compared to 0IHG (n = 186) was associated with a lower body weight (BW), a lower BMI, smaller waist circumference (WC), higher HDL-cholesterol levels (HDL), lower triglyceride levels (TAG), a better HDL/TAG index, lower HbA_1c and more frequent treatment with insulin. LDL-cholesterol levels (LDL), the values of blood pressure (BP), glomerular filtration (eGF), urine albumin and creatinine ratio (UACR), the ratio between smokers and patients with hypertension did not differ among the groups, and the proportion of patients with eGF < 60ml/1.73m²was higher in the group with > 3IHG and was not associated with an increased or lower occurrence of CVD, ENDO, ONCO or any other monitored comorbidities.

Conclusion: The results highlighted the heterogeneity of patients with DM2T, which is also shown in a IHG occurrence, while a higher IHG occurrence was associated with a lower BW and BMI, smaller waist circumference, higher HDL levels, lower TAG levels, a lower HbA_1c, a higher proportion of patients with eGF < 60ml/1.73m² and more frequent insulin treatment. These characteristics are probably linked to a lower level of insulin resistance and also a more frequently occurring chronic kidney disease. Other parameters of CV risk, such as LDL-cholesterol levels, BP, eGF, UACR values or the ratio between smokers and patients with hypertension did not differ among the groups. A higher occurrence of IHG was not associated with an increased or lower occurrence of CVD, ENDO, ONCO or any other monitored comorbidities. However the results will need to be verified in a larger cohort of patients.

Keywords:

hypoglycemia – clinical characteristics – complications – type 2 diabetes mellitus

Zdroje

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