Abstract
The recent grading of severity of hypoglycemia for use in clinical practice using Ademolus Classification of Hypoglycemia (ACH) is opening a new knowledge path and insight in hypoglycemia complicating diabetes mellitus management. In Africa like other parts of the world, hypoglycemia complicates diabetes mellitus management in in and out-patients. This article aims to examine hypoglycemia occurring in African diabetics on out patient pharmacologic management. This is a retrospective study of 200 hypoglycemic episodes occurring in 88 diabetics attending the out patients of the Endocrinology Clinic of Lagos State University Teaching Hospital, Lagos, Nigeria. Over 13years and 9 months period. Data were analysed using ADEMOLUS CLASSIFICATION OF HYPOGLYCEMIA and American Diabetes Association (ADA)/European Association for the Study of Diabetes (EASD) 2018 Classification of Hypoglycemia. Only documented hypoglycemic episodes were studied using a questionnaire. The inclusion criteria includes known diabetics, documented hypoglycemic episodes occurring during out patient pharmacologic management. This study was analysed using SPSS version 17. Of the 200 hypoglycemic episodes studied, 79.5% were grade 1, grade 2 were 18% while 2.5% were grade 3. In all type 2 diabetics (T2DM), 82.9% had grade 1 hypoglycemia, 14.6% had grade 2, while 2.4% had grade 3. The lowest hypoglycemic episode among out patient T2DM was an asymptomatic value of 29mg/dl (grade 3 hypoglycemia!). There is an inverse relationship between hypoglycemic episodes recorded in type 1 and type 2 diabetics as the pearson correlation was -1.000. This denotes a perfect negative correlation between hypoglycemic episodes developed in type 1 compared to type 2 diabetics in Africans. There is no linear relationship between these two variables. With a p-value of 0.000, the null hypothesis is discarded in this study as these findings is not due to chance or error of sampling but rather are statistically significant. ADA/EASD 2018 classification of hypoglycemia is not very sensitive in diagnosing severe hypoglycemia in that it recognized only 1 hypoglycemic episodes while ACH recognizes five. The five cases all have blood sugar of less than 40mg/dl yet ADA/EASD 2018 classification recognizes only one because it developed a severe event from hypoglycemia needing assistance from a third party. The majority of T2DM had mild hypoglycemic episodes irrespective of whether they are on oral hypoglycemic agents (OHA) alone, or on OHA and insulin or on insulin alone. Among African T1DM, grade 1 hypoglycemia is twice as common as grade 2 hypoglycemia while severe hypoglycemia is not common. Grades 1, 2 and 3 hypoglycemia can all occur in African diabetics on out patients basis but with the majority occurring as grade 1. Asymptomatic grade 3 hypoglycemia can occur in out patient African T2DM. A similar study is advised in other regions of the world.
Highlights
An estimated 8.8% of world adult population between 20 to 79 years have diabetes mellitus in 2017, [1] this translate to about 425 millions of world population
By using the pearson correlation, there is an inverse relationship between hypoglycemic episodes recorded in type 1 and type 2 diabetics as the Pearson correlation was -1.000
The lowest hypoglycemic episode among the type 2 subjects was a value of 29mg/dl occurring in an out patient and was asymptomatic! The doctor noticed and pen this down in the case file asymptomatic hypoglycemia can occur in grade 3 in African diabetics on out patient management
Summary
An estimated 8.8% of world adult population between 20 to 79 years have diabetes mellitus in 2017, [1] this translate to about 425 millions of world population. An estimated 16 millions of these diabetic figures are in the region of Africa. It is estimated that in 2017 about 726.7 billion U.S dollars were spent worldwide on health care expenditure due to diabetes mellitus, out of this only 3.3 billion U.S dollars was spent in Africa on health care expenditure due to diabetes mellitus!. In a review article of twenty six articles where the costs. Using Ademolus Classification of Hypoglycemia presented in the studies under review is converted to 2015 international dollars prices (I$) [2]. Annual national direct costs of diabetes differed between countries in Africa and ranged from I$3.5 billion to I$4.5 billion per annum. In studies that reported both drug costs and total costs, drug costs took a significant portion of the total costs per patient. The highest burden due to the costs associated with diabetes was reported in individuals within the low income group (2)
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
