MON-168 Hypoglycemia in Diabetics 65 Years and Older in Africans and Ademolus Classification of Hypoglycemia

Abstract

An aging population, a risk factor for diabetes mellitus ,forms different proportion of national population across Africa and the world over. This research seek to answer the question what clinical deduction can be derived from the management of diabetics 65 years and above (DM65YRS&A) in African when Ademolus Classification of Hypoglycemia (ACH) is used as a tool in this age bracket? This is a retrospective study of 183 documented hypoglycemic episodes occurring in 66 diabetics in Africa over a 13 years period. Randomly selected casenotes of DM65YRS&A with hypoglycemic episodes whether as in or out patients were thoroughly studied. Exclusion criteria include probable hypoglycemia, hypoglycemia in non diabetics, and hypoglycaemia in diabetics aged below 65years. Hypoglycemia was defined as blood sugar of 70mg/dl or less. CIinical deduction were made using ACH as a tool. All cases studied were type 2 diabetics. Of the 183 hypoglycemic episodes studied,98 episodes occurred during in patient while 85 episodes occurred during out patient diabetes management. Of the 66 diabetics studied, 22 were in patients while 42 were out patients. Age range among in patients was 65 to 95 years while age range among out patients was 65 to 87 years.Severe hypoglycemia occurred in 15% of DM65YRS&A as in patients while none of the DM65YRS&A managed as out patients had severe hypoglycemia.The tendency for diabetics to develop hypoglycemia is more with in patient management when blood sugar control is more intensive compared to with out patient management.Hence clinicians need to be less aggressive on blood sugar control in DM65YRS&A on admission because the risk of severe hypoglycemia is more than when they are on out patients management..Also from this study,it can be deducted that if DM65YRS&A is having life threatening problem with repeated severe hypoglycemia while on insulin and oral hypoglycemic agents (OHA) then consider placing them on OHA alone as this reduces the risk of hypoglycemia from moderate to mild. Similarly, if they are on both insulin and oral hypoglycemic agents ,risk of developing moderate to severe hypoglycaemia is less if they are placed on insulin therapy alone.However the risk of hypoglycemia is much less when switched from the combination to OHA alone than to insulin alone.While grade 1 hypoglycemia is the commonest in 7th 8th and 9th decades of life, grade 2 is in the 10th decades. Evidence based, clinically relevant practice based guideline and deduction can be made when ACH is used as a tool in management of DM65YRS&A in Africa. What of in other races?How does ACH as a tool affects montreal cognitive assessment,Katz index and the Lawton instrumental activities of daily living in African and the world in geriatrics? References : Ademolu AB (2017) Role of Ademolus Classification of Hypoglycemia in Blood Glucose and Diabetes Mellitus Management. Gastroenterol Liver Clin Med (2017) 1:1 003 Nothing To Disclose.