Prevalence Of Hypoglycemia Research Articles

Increased Risk of Hypoglycemia Following Roux-en-Y Gastric Bypass Surgery in Patients Without Diabetes: a Propensity Score-Matched Analysis.

Roux-en-Y gastric bypass (RYGB) surgery is an effective treatment for obesity. However, the incidence and long-term risk of hypoglycemia after surgery in patients without diabetes remains unclear. This study aimed to investigate the prevalence of hypoglycemia following RYGB surgery in patients with obesity and without diabetes. A retrospective cohort study was conducted using the TriNetX database. The study population included 15,085 patients with obesity (BMI ≥ 30kg/m2) who underwent RYGB surgery and 3,200,074 non-surgical controls, all without a history of diabetes or GLP-1 receptor agonist use. Propensity score matching was performed to balance baseline characteristics. The primary outcome was the incidence of hypoglycemia, defined by ICD-10-CM codes or laboratory values (glucose ≤ 70mg/dL). Cox regression analysis was employed to calculate hazard ratios (HR) and 95% confidence intervals (CI). In the overall study population, the risk of hypoglycemia was significantly higher in the RYGB group (18.70%, n = 2,810) compared to the control group (3.80%, n = 120,923; HR 4.3, 95% CI 4.14-4.46, p < 0.001). After propensity score matching (n = 14,916 per group), RYGB patients maintained an elevated risk (18.70%, n = 2,795) compared to matched controls (5.0%, n = 749; HR 3.7, 95% CI 3.44-4.05, p < 0.001). Time-series analysis revealed consistently higher hypoglycemia risk in the RYGB group, with hazard ratios ranging from 5.37 (95% CI 4.09-7.03) at 1week to 3.75 (95% CI 3.45-4.06) at 10years post-surgery (all p < 0.001). Subgroup analysis of RYGB patients who developed hypoglycemia showed a 30-day hospitalization rate of 21.3% and a mortality rate of 0.71%. RYGB surgery is associated with a significantly increased risk of hypoglycemia in patients with obesity and without diabetes, both in the short-term and long-term follow-up. These findings underscore the importance of monitoring and managing hypoglycemia in patients undergoing RYGB surgery, even in the absence of preexisting diabetes.

Insulin requirement trajectories during COVID-19 versus non-COVID-19 critical illness-A retrospective cohort study.

The glycemic response to critical COVID-19 remains uncertain. We aimed to assess the association between COVID-19, insulin requirements, glycemic control, and mortality in intensive care unit (ICU) patients. We conducted a retrospective observational study of 350 COVID-19 patients and 1067 non-COVID-19 patients admitted to the ICU. Insulin requirement was defined as the total units of exogenous insulin required to cover one gram of administered carbohydrates (insulin-to-carbohydrate ratio, ICR). We used multivariable generalized linear mixed-model (GLMM) analysis to assess the association of the interaction between COVID-19 and ICU-day with daily ICR, adjusted for fixed and time-dependent covariates. Glycemic control was assessed after stratification on diabetes and COVID-19. We used multivariable logistic regression analysis to assess the association between ICR and 90-day mortality. The mean (95% CI) of the mean daily ICR among patients without diabetes was 0.09 (0.08-0.11) U/g and 0.15 (0.11-0.18) U/g in the non-COVID-19 group and COVID-19 group (p = .01), respectively. In diabetes patients, the corresponding ICRs were 0.52 (0.43-0.62) U/g and 0.59 (0.50-0.68) U/g (p = .32). In multivariable GLMM analysis, the interaction between COVID-19 and ICU-day was independently associated with ICR (risk estimate 1.22, 95% CI 1.15-1.31, p < .001). COVID-19 was associated with higher hypoglycemia prevalence irrespective of diabetes status, higher average glucose levels, more pronounced glucose variability, and a lower proportion of glucose values within target range among patients without diabetes. On multivariable logistic regression analysis, the adjusted odds ratio for 90-day mortality was 1.77 (95% CI 0.94-3.34, p = .076) per one unit increase in mean ICR. In our cohort of ICU patients, COVID-19 was associated with higher daily insulin requirements per gram of administered carbohydrates, and worse glycemic control. We found no robust association between ICR and increased odds of death at 90 days.

Impact of Hypoglycemia on Hospitalized Patients With Hepatocellular Carcinoma.

Aims Hepatocellular carcinoma (HCC) is one of the common liver malignancies that presents a challenge to global healthcare. The impact and outcomes of hypoglycemia in HCC have not been studied in detail before. This study aimed to investigate the outcomes and prognosis associated with hypoglycemia in patients diagnosed with HCC, utilizing a large-scale database approach. Methods Using the Nationwide Inpatient Sample (NIS) database from 2017 to 2020, we conducted a comprehensive retrospective analysis to examine the incidence, risk factors, and clinical implications of hypoglycemia on HCC patients. The patients were divided into two groups: those with hypoglycemia and those without hypoglycemia. Univariate and multivariate logistic regression were used to conduct the analysis. STATA® version 17.0 software(StataCorp LLC, College Station, TX) was used for this purpose. Results Out of a total of 343,895 patients with HCC, the prevalence of hypoglycemia was present in 1.5% of this patient population. We found that hypoglycemia was common in the male population (68%). Compared with patients without hypoglycemia, patients who had hypoglycemia with HCC had higher mortality (42%, p-value < 0.05) and higher risks of secondary outcomes such as hepatic failure, spontaneous bacterial peritonitis (SBP), ascites, and portal vein thrombosis compared to patients who did not have hypoglycemia. The multivariate-adjusted odds ratio for hepatic failure was 2.7 (2.3-3.1), for SBPwas 2.9 (1.8-3.0), for ascites was 1.6 (1.4-1.9), and for portal vein thrombosis was 1.2 (0.9-1.4). Conclusion In conclusion, hypoglycemia in HCC is associated with increased mortality and worse outcomes.

Prevalence and Risk Factors of Spontaneous Hypoglycemia in Hospitalized Patients: Cross-Sectional Observational Study and Literature Review

Introduction: Spontaneous hypoglycemia is a blood glucose level below 70 mg/dL unrelated to insulin or oral hypoglycemic agents. Objectives: To assess the prevalence of spontaneous hypoglycemia (&lt;70 mg/dL) in adult patients admitted to Hospital Santa Izabel in 2023. Additionally, a narrative review was conducted to evaluate the prevalence, risk factors, main contributing factors, and mortality associated with spontaneous hypoglycemia in hospitalized patients. Methods: A cross-sectional observational study reviewed an electronic medical record database of adult patients. Capillary blood glucose measurements from patients admitted to general wards, intensive care units (ICUs), and emergency services at Hospital Santa Izabel (HSI) in 2023 were analyzed. A narrative review was also performed through a non-systematic PubMed search using the terms hypoglycemia, mortality, hospital, and individuals without diabetes. The search yielded 61 articles, which, along with reference analysis, brought the total to 81 articles. After excluding duplicates and studies irrelevant to the topic, 10 articles were selected for analysis. Results: In 2023, HSI recorded 6,609 episodes of hypoglycemia, accounting for 2.63% of the blood glucose measurements. The prevalence of spontaneous hypoglycemia in the reviewed articles ranged from 0.01% to 0.51%. Spontaneous hypoglycemia occurs more frequently in ICU patients and the elderly. Common risk factors included heart failure, renal failure, malignancy, and pre-existing diabetes. Severe conditions such as cirrhosis, multiple organ failure, polytrauma, and sepsis were also associated with hypoglycemia. Moreover, spontaneous hypoglycemia was linked to higher mortality, with 5 out of 10 studies showing mortality rates 2 to 3 times higher in patients who experienced at least one episode. This association was not commonly observed in insulin-induced hypoglycemia. Conclusion: Spontaneous hypoglycemia in hospitalized patients is a rare event, typically associated with severe acute conditions and advanced age. It is more frequently linked to higher mortality compared to medication-induced hypoglycemia, with mortality rates correlating with the severity of the hypoglycemic episodes.

Awareness and Occurrence of Hypoglycemic Episodes among Type 2 Diabetic Patients Under Treatment at a Tertiary Healthcare Center in Chennai

Background One of the greatest threats to achieving tight glycemic control is hypoglycemia, which can lead to decreased drug compliance, cardiovascular events, and even mortality. This study was conducted to estimate the proportion of diabetic patients who have encountered hypoglycemic episodes and to assess the knowledge and practice regarding hypoglycemia episodes will aid the primary care physician to achieve better glycemic control of the diabetic patients and provide patient education to prevent hypoglycemia.MethodsThis was a cross-sectional study conducted among 196 patients with type 2 diabetes mellitus getting treated in Non communicable disease clinic (NCD clinic) in a tertiary care institution in Chennai. Participants were selected by consecutive sampling and data was collected using a semi structured interview schedule after getting informed consent from the participants. ResultsPrevalence of hypoglycemia was 75.0%. The first reported symptom of hypoglycemia was sweating (80.0%). The most common etiological factor leading to hypoglycemia was missing a meal according to the participants (90.0%). About 80% of the participants felt that hypoglycemia episodes could be prevented by taking the right amount of medication at time. Conclusions This study has established the high prevalence of self-reported hypoglycaemia in the urban setting. This urges the need for the physicians to enquire about the hypoglycemia symptoms to all diabetic patients at each visit. It is also important to educate these patients about the symptoms of hypoglycemia and the importance of reporting of such symptoms, which will help in adjusting dose and preventing future attacks.

AGE, DISEASE DURATION AND MULTIMORBIDITY AS PREDICTORS OF HYPOGLYCEMIA IN ELDERLY AND SENILE WOMEN WITH TYPE 2 DIABETES MELLITUS

AbstractAim – to study the relationship between age, duration of the disease and concomitant chronic non-infectious pathology with the risk of developing hypoglycemia in patients with type 2 diabetes mellitus (T2DM).Material and methods. The study involved 90 elderly and senile women (mean age 70.5 ± 6.2 years) with T2DM. A detailed history of the disease was collected from all study participants, and medical documentation was studied. The indicators of clinical blood test and biochemical blood test were studied, and the Charlson comorbidity index was calculated.Results. The prevalence of hypoglycemia among patients with T2DM was: 47% in the elderly and 75% in senile patients. The correlation index between the indicators “Patient’s age” and “Presence of hypoglycemia” was r = 0.2489 (p = 0.018), which indicates a statistical dependence of these values. When calculating χ2 (chi-square), the value obtained was χ2 = 5.513 (p = 0.018). One-way analysis of variance on these values shows a result of F-ratio = 5.811 at the significance level (p = 0.018), which confirms a significant relationship between the two variables. The correlation index was calculated for the indicators “Presence of cases of hypoglycemia” and “Existence of diabetes mellitus” (r = 0.3512 with a significance level of p = 0.0007). The data allows us to draw a conclusion about the statistical dependence of these values. The result of the χ2 test for trend was the value χ2 (trend) = 10.982, (p = 0.0009). The data presented indicate the relationship between these variables. The correlation between the indicators “Presence of cases of hypoglycemia” and “Charlson Comorbidity Index (scores)” is confirmed by the value r = 0.4020 (p = 0.0001). The relationship between these variables was revealed by calculating χ2 = 16.336, (p = 0.0059). Based on the χ2 test for trend, the value χ2 (trend) = 14.544, (p = 0.0001) was obtained. One-way analysis of variance for these indicators shows the result of F-ratio = 3.734 (p = 0.004).Conclusion. The patient's age, duration of T2DM and multimorbidity are significantly associated with the risk of hypoglycemia in patients with T2DM.

Prevalence and Associated Factors of Hypoglycemia among Severe Acute Malnourished Children who admitted in East Gojjam Zone Public Hospitals from 2018 to 2021, Northwest Ethiopia, 2022. Multi-center Retrospective Cross Sectional Study

Background: Globally, severe acute malnutrition (SAM) remains a major killer of children under 5 years of age. The highest magnitude is seen in sub-Saharan Africa, including Ethiopia. Hypoglycemia is the most common complication of severe acute malnutrition (SAM) and the most life-threatening condition in pediatric society. This study aimed to assess the prevalence of hypoglycemia and its associated factors among under-five children with severe acute malnutrition. Methods: A cross-sectional retrospective study was conducted among 378 randomly selected samples who were admitted to public hospitals in the East Gojjam zone from 2018 to 2021. Data was extracted from the medical records of the children and entered into SPSS version 26, Variables with a p – value &lt; 0.25 in the Bivariate analysis were candidates for multivariable logistic regression and those with a p – value &lt; 0.05 in the multivariable analysis were considered as having a statistically significant association with hypoglycemia among severe acute malnutrition. Results: Out of 378 respondents, 50 (13.2%) had hypoglycemia with severe acute malnutrition patients. Children admitted between the ages of 0-6 months were 2.93 (AOR = 1.57-6.25, p = 0.000), shocks were 4.6 (AOR = 1.25-17.42, p = 0.034), and fully immunized children were (AOR: 2.61 (1.01- 6.77, p = 0.048) was significantly associated with hypoglycemia with severe acute malnutrition. Conclusion and recommendation: The prevalence of hypoglycemia with severe acute malnutrition was 13.2%. We also recommend a longitudinal study should be done among children who develop hypoglycemia with severe acute malnutrition to determine the long-term consequences, especially the neurodevelopmental sequelae associated with this condition.

Comparative efficacy and safety of weekly dulaglutide versus weekly insulin in type 2 diabetes: A network meta-analysis of randomized clinical trials

BackgroundAdvancements in type 2 diabetes mellitus (T2DM) therapy, notably with weekly agents like glucagon-like peptide-1 receptor agonists (GLP-RAs) such as dulaglutide, offer promising outcomes in clinical practice. The emergence of once-weekly insulin adds to this therapeutic arsenal. This research aims to explore and compare the efficacy and safety profiles of these agents in diabetes management, facilitating informed decision-making for optimizing their utilization in clinical practice. MethodsA systematic search of PubMed, Scopus, Cochrane, and Web of Science databases was conducted. The research protocol was registered at OSF registries (https://osf.io/gd67x). The primary outcome of interest was the change in hemoglobin A1C (HbA1c), with secondary outcomes including the change in fasting plasma glucose, body weight, prevalence of hypoglycemia, and treatment discontinuation due to adverse events. The evaluation of bias risk was conducted utilizing the RoB2 tool developed by the Cochrane Collaboration. Statistical analysis was performed using RStudio version 4.3.2 with the meta package version 7.0–0 and the netmeta package version 2.9–0. Confidence in network meta-analysis estimates was evaluated using the CINeMA (Confidence In Network Meta-Analysis). Heterogeneity was assessed by comparing the magnitude of the common between-study variance (τ2) for each outcome with empirical distributions of heterogeneity variances. ResultsDulaglutide 1.5 mg (mg) weekly demonstrated superior reduction in hemoglobin A1C (HbA1c) compared to insulin, with a mean difference (MD) of −0.35 (95 % CI: −0.51 to −0.19). Additionally, Dulaglutide 1.5 mg exhibited greater weight loss, with an MD of −3.12 (95 % CI: −3.55 to −2.68). However, it also showed a higher rate of adverse events, with an odds ratio (OR) of 1.40 (95 % CI: 1.12 to 1.75) compared to insulin. Both doses of Dulaglutide (1.5 mg and 0.75 mg) had lower prevalence of hypoglycemia compared to insulin, with ORs of 0.60 (95 % CI: 0.41 to 0.87) and 0.59 (95 % CI: 0.41 to 0.86), respectively. There was no significant difference in treatment discontinuation among the treatment groups. ConclusionDulaglutide, particularly at higher doses, demonstrates superior efficacy in lowering hemoglobin A1C and reducing hypoglycemia risk compared to Icodec insulin in type 2 diabetes management. However, its use is also associated with a higher incidence of adverse events. Clinicians should carefully consider these factors when selecting optimal treatment strategies for patients with type 2 diabetes mellitus.

Hypo-glycaemia and Associated Factors among Type 1 Diabetes Mellitus Patients Attending the Outpatient Clinics of Debre-tabor Compressive and Specialized Hospital, South Gondar Zone, North West Ethiopia: A Cross-sectional Study

Introduction: Hypoglycemia affects patient safety and glycemic control during insulin treatment of both type 1 (T1DM) and type 2 diabetes mellitus (T2DM). It is still a major clinical problem in the treatment of type 1 diabetes that impairs metabolic control. This study aimed to assess hypoglycemia and associated factors among type 1 diabetes mellitus patients attending the outpatient clinics of Debra–Tabor Comprehensive and Specialized Hospital, in 2021. Method: institutional-based cross-sectional study design was conducted among 204 selected type I DM, from June 1/2021 to August 30/2021. The study participants were selected by systematic sampling method from monthly follow-up lists and lists of registration. Data were cleaned and entered into Epi Data and then exported into SPSS version 20 for analysis. Data were presented with texts, graphs, diagrams, and tables but an analytic form of findings will be presented by text form of the odds ratio. Bivariable and multivariable binary logistic regression models were fitted to identify factors associated with hypoglycemia p – value &lt; 0.05 was considered statistically significant and reported as a 95% confidence interval (CI). Results: A total of 204 participants participated with a response rate of 100%, and prevalence of self-reported hypoglycemia was 88.7% (95%, CI: 83.8-92.6) and the prevalence of hypoglycemia was significantly associated with occupation [AOR: 4.01 (95% CI:1.86-9.35)], higher educational status [AOR: 2.13 (95% CI:1.92-13.15)], diabetic duration &lt; 1 [AOR: 3.80 (95% CI:1.32-9.28)], poor knowledge [AOR: 4.91 (95% CI:1.09-11.06)] and favorable attitude [AOR: 5.86 (1.10-6.07)]. The current study revealed that the knowledge, attitude, and practice of respondents were 81.9% (95%, CI, 76-86.8), 73% (95% CI, 66.7-78.9), and 91.2% (95% CI, 86.8-94.6) respectively. Conclusion and recommendation: Hypoglycemia was highly prevalent among diabetic patients treated at Debra-Tabor Comprehensive and Specialized Referral Hospital. To reduce the higher prevalence of hypoglycemia the health professionals working in the hospital had better provide appropriate patient advice about, BGL monitoring, medication adherence, self-injection as well as oral hypoglycemic agent administrations.

Frequency of Hypoglycemia in Neonates with Hypoxic-Ischemic Encephalopathy in the Neonatal Intensive Care Unit of Sir Ganga Ram Hospital, Lahore

Background: Hypoxic-ischemic encephalopathy (HIE) often necessitates admission to neonatal intensive care units (NICUs) for specialized care.– Among the various complications associated with HIE, hypoglycemia is a notable concern due to its potential to exacerbate neurological injury and compromise neurodevelopmental outcomes. However, the frequency of hypoglycemia in neonates with HIE, particularly in resource-limited settings like Pakistan, remains poorly characterized. Objectives: Aim of this study is to determine the frequency of hypoglycemia in neonates with HIE admitted to the NICU of Sir Ganga Ram Hospital, Lahore, Pakistan. By systematically reviewing medical records, this study is aimed to describe the prevalence of hypoglycemia in this population.Methods: Medical records of neonates diagnosed with HIE and admitted to the NICU were reviewed from July 2023 to October 2023. Data on demographic characteristics, perinatal history, clinical presentation, laboratory investigations including blood glucose levels, and neurodevelopmental outcomes were extracted. The frequency of hypoglycemia was determined as the proportion of neonates with documented hypoglycemia among all neonates diagnosed with HIE during the study period. Results: Among the cohort of neonates diagnosed with HIE (n = 120), 20.8% were found to experience hypoglycemic episodes during their hospital stay. Subgroup analyses revealed associations between hypoglycemia and variables such as gestational age, birth weight, and severity of HIE. Descriptive statistics were used to summarize the demographic characteristics of this population, providing context for understanding the prevalence and implications of hypoglycemia in neonates with HIE. Conclusion: This study highlights the prevalence of hypoglycemia as a common metabolic disturbance in neonates with HIE, underscoring the need for vigilant monitoring and prompt intervention in this vulnerable population. Standardized protocols for managing hypoglycemia in neonates with HIE are imperative to optimize clinical outcomes.

Factors and economic burden of non-severe hypoglycemia among insulin-treated type 2 diabetes patients: a cross-sectional study

Objective This cross-sectional survey was performed to assess the prevalence, factors, and economic burden of non-severe hypoglycemia among insulin-treated type 2 diabetes (T2D) patients in northern Thailand. Methods Between April 2021 and August 2022, 600 participants were evaluated via structured questionnaires containing sociodemographic and clinical characteristics, medications, and economic burden. Patients were divided into two groups (having and not having non-severe hypoglycemia). Variables with a p value <.05 in the univariate model were included in the multivariate model. Results The percentage of non-severe hypoglycemia was 50.3% (302/600). Of all participants, the average age was 61.4 ± 26.0 years, 55.7% were female, 53.5% used premix insulin, and the average duration of diabetes was 16.1 ± 10.0 years. Multivariate logistic regression analysis indicated that age (OR = .96; p <.001), duration of diabetes (OR = 1.04; p <.001), BMI (OR = .95; p = .002), thiazolidinedione (OR = 1.56; p = .012) and insulin regimens were associated with having non-severe hypoglycemia. Compared to basal insulin, basal bolus (OR = 6.93; p = .001), basal plus (OR = 3.58; p <.001), and premix insulin (OR = 1.83; p =.003) were associated with hypoglycemia. Greater numbers of sick leave were found in the hypoglycemia group (14 vs 4 patients, p = .029). Conclusions These findings help to individuate those patients who are at higher risk of non-severe hypoglycemia in insulin-treated T2D patients. Compared to the non-hypoglycemia group, patients with hypoglycemia were younger, had longer diabetes duration, lower BMI, received thiazolidinedione and insulin regimens such as premix, basal plus, or basal bolus insulins, and more productivity loss.

Prevalence and predictors of hypoglycemia in older outpatients with type 2 diabetes mellitus.

The prevalence of type 2 diabetes (DM) has been increasing globally, particularly among older adults who are more susceptible to DM-related complications. Elderly individuals with diabetes are at higher risk of developing hypoglycemia compared with younger diabetes patients. Hypoglycemia in elderly patients can result in serious consequences such as cognitive changes, increased risk of falls, heart and other vascular problems, and even high mortality rate. To assess prevalence, and factors associated with hypoglycemia events among geriatric outpatients with type 2 diabetes mellitus. The study was conducted at King Abdullah University Hospital (KAUH) at the outpatient diabetes clinic from October 1st, 2022 to August 1st, 2023. Variables such as socio-demographics, medication history, and comorbidities were obtained using electronic medical records. The prevalence of hypoglycemia was determined through patient interviews during their clinic visit. Patients were prospectively monitored for hospital admissions, emergency department visits, and mortality using electronic medical records over a three-month follow-up period. Logistic regression models were conducted to identify factors associated with hypoglycemia and hospital admissions/ emergency visits. Ethical Approval (Reference # 53/151/2022) was obtained on 19/9/2022. Electronic medical charts of 640 patients who have type 2 diabetes mellitus and age ≥ 60 years were evaluated. The mean age ± SD was 67.19 (± 5.69) years. Hypoglycemia incidents with different severity levels were prevalent in 21.7% (n = 139) of the patients. Insulin administration was significantly associated with more hypoglycemic events compared to other antidiabetic medication. Patients with liver diseases had a significantly higher risk of hypoglycemia, with odds 7.43 times higher than patients without liver diseases. Patients with dyslipidemia also had a higher risk of hypoglycemia (odd ratio = 1.87). Regression analysis revealed that hypoglycemia and educational level were significant predictors for hospital admission and emergency department (ER) visits. Hypoglycemia was a positive predictor, meaning it increased the odds of these outcomes, while having a college degree or higher was associated with reduced odds of hospital admission and ER visits. Current study identified a considerable prevalence of hypoglycemia among older patients with type 2 diabetes, particularly, among those with concurrent liver diseases and dyslipidemia. Furthermore, hypoglycemia was associated with an increased rate of emergency department visits and hospital admissions by 2 folds in this population.

Hypoglycemia in Terminally Ill Patients with Cancer with a History of Diabetes Mellitus Admitted to a General Ward: A Retrospective Observational Study.

Poor glycemic control may be a risk factor for hypoglycemia in terminally ill patients with cancer with a history of diabetes mellitus (DM). However, no guidelines have been established for achieving glycemic control in this patient population, and epidemiological information remains lacking. We aimed to investigate the prevalence of hypoglycemic episodes and provide epidemiological information on hypoglycemia in terminally ill patients with cancer with a history of DM admitted to a general ward. This was a single-center, retrospective, observational study. This study enrolled terminally ill patients with cancer with a history of DM, receiving palliative care at a hospital in Japan between January 2017 and July 2022. Data extracted from the patients' medical records were age, sex, body mass index, primary cancer, liver metastases, dialysis status, Eastern Cooperative Oncology Group performance status score, type and duration of DM, HbA1c level, and use of diabetes medications (antihyperglycemic agents and types and insulin) at the time of initial visit within 180 days of death. Among the 104 patients included in the analysis, hypoglycemic episodes occurred in 36 patients (34.6%). The total number of hypoglycemic episodes was 132, and the median number of hypoglycemic episodes for each patient during hospitalization was 2.5 (interquartile range, 1-6). The prevalence of hypoglycemia in terminally ill patients with cancer with a history of DM who were admitted to a Japanese general ward was 34.6%. Further studies are needed to determine the frequency of hypoglycemia because of overtreatment in this patient population.

Recurrent Hypoglycemia Following Asparaginase Therapy for Pediatric Lymphoid Malignancies

Background: Asparaginase (ASP) is critical in acute lymphoblastic leukemia (ALL) and lymphoma (LLy) therapy. Hyperglycemia following ASP is described, but hypoglycemia is rarely reported. We previously reported on the risk factors, prevalence, duration, severity, recurrence, and outcomes of children at Texas Children's Hospital (TCH) developing ASP-induced hypoglycemia (defined as blood glucose [BG] &amp;lt;70mg/dL). Out of 723 ALL or LLy patients, there was a 7.6% prevalence of ASP-induced hypoglycemia in pediatric patients with ALL (n=50) or LLy (n=5), and occurred with both pegylated and Erwinia formulations of ASP. Given the median hypoglycemia duration was 11 days in our cohort and 76% of our cohort experience recurrent hypoglycemia with subsequent ASP doses, we here report the management details of these patients to provide guidance for other providers. Design/Method: Descriptive analysis of cohort of children with ASP-induced hypoglycemia at TCH between 6/1/2017 and 6/30/2022. Following identification of diagnosis and frequency of hypoglycemia events, we reviewed EMR to collect information on treatments utilized including evaluation with a registered dietician (RD), dietary changes recommended during hypoglycemia, and utilization of cornstarch supplementation, continuous feedings or use of continuous glucose monitor (CGM). Hypoglycemia severity was determined based on lowest recorded BG (Stages 1-2) and need for hospitalization or seizures (Stage 3). Results: 26% of patients had Stage 1 hypoglycemia (n=14), 47%% had Stage 2 hypoglycemia (n=26), and 25% had Stage 3 hypoglycemia (n=15) (Figure 1). Treatment to prevent symptomatic/severe hypoglycemia included: 1) dietary change (53%, n=29), 2) cornstarch (29%, n=16), and 3) continuous enteral feedings (13%, n=7). Dietary change included education on complex carbohydrates and a consistent carbohydrate diet. Cornstarch dosing was determined in consultation with endocrinology, and typically doses were provided prior to periods of prolonged fasting (e.g., overnight, NPO). Enteral feedings were administered through daytime bolus feedings and continuous overnight feedings, with the goal of a consistent carbohydrate infusion and maintaining BG levels &amp;gt;70 mg/dL. Five patients (9%) required all 3 interventions. Dietary education and subsequent follow up was completed by an RD in 54% of patients (n=30), and among patients with multiple recurrences, 67% had RD involvement (n=37). Nine patients in our cohort (16%) used CGM to closely monitor adequacy of carbohydrate intake. The primary team evaluated home BG logs weekly. Despite frequent treatment or nutritional management, only 39 (69%) of individuals had formal endocrine consultation, most commonly those with Stage 3 hypoglycemia (13 of 14; 93%). Patients with Stage 3 hypoglycemia tended to be younger (median age 2.8 years), tended to require the most intensive therapy (47% Vs 38% Vs 15% requiring medical therapy for Stages 3 ,2, and 1), and were more often to require nutritional counseling (79% Vs 46% Vs 42%). Only one patient had ASP held due primarily to hypoglycemia (Stage 3 hypoglycemia), while another patient had it held primarily for ASP-induced pancreatitis but had Stage 1 hypoglycemia. The overall survival of our cohort was 80% (85% if excluding patients receiving ASP for relapsed disease), with 3.5 years' median follow up. Conclusion: ASP-induced hypoglycemia is a fairly common, recurrent, and possibly severe potential side effect in children receiving treatment for ALL or LLy. Reassuringly, patients completed treatment without worsened survival. However, some patients required intensive therapy throughout the duration of ASP treatments and required multi-modal therapy and intensive monitoring (Figure 2). Our systematic approach was effective at reducing severe events and hospitalizations, without compromising survival after therapy completion. We recommend other centers consider close monitoring and developing treatment algorithms to detect and manage ASP-induced hypoglycemia.

Neonatal Hypoglycemia following Late Preterm Antenatal Corticosteroid Administration in Individuals with Diabetes in Pregnancy.

Antenatal corticosteroid (ACS) administration is standard practice for pregnant individuals delivering in the late preterm period, though no guidelines are in place for those with diabetes. This study aims to characterize the prevalence of neonatal hypoglycemia after ACS administration in pregnant individuals with diabetes delivering in the late preterm period. This is a retrospective, single-center, case-control study of individuals with diabetes who delivered between 340/7 and 366/7 weeks' gestation at a large academic medical center from 2016 to 2021. A total of 169 individuals were included in the analysis; 87 received corticosteroids and 82 did not. The proportion of neonates with hypoglycemia, neonatal intensive care unit (NICU) admission, respiratory distress syndrome, and hyperbilirubinemia were compared between parents who received ACSs versus those who did not. The prevalence of neonatal hypoglycemia (40.2 vs. 23.2%, p = 0.027), requiring treatment (40.3 vs. 22.4%, p = 0.041), and hyperbilirubinemia (35.6 vs 18.5%, p = 0.018) was greater for neonates born to individuals with diabetes who received late preterm ACSs compared with those who did not. There was no difference in NICU admission and respiratory distress between the groups. These results remained unchanged after controlling for confounders including gestational age at delivery and birth weight. This study demonstrates that late preterm corticosteroid administration to pregnant individuals with diabetes increases the risk for neonatal hypoglycemia without changing the rates of respiratory morbidity. · Late preterm ACS in diabetic patients resulted in higher rates of neonatal hypoglycemia.. · There are no differences in rates of respiratory distress syndrome and transient tachypnea of the newborn between the ACS group and control group.. · There was no noted difference in rate of NICU admission and length of stay between the two groups..

Factors associated with knowledge and hypoglycemia experience among patients with diabetes mellitus in Ghana: A cross‐sectional study

AbstractBackgroundAmong persons with diabetes on treatment, hypoglycemia is the most common iatrogenic acute metabolic complication. Many factors influence hypoglycemia, highlighting the need for diabetic patients to recognize, and manage these potential factors in order to reduce the rate of hypoglycemia. In this study, we assessed the knowledge, experiences of hypoglycemia, and associated risk factors among Ghanaians with diabetes mellitus (DM).MethodsThis cross‐sectional study included 444 clinically diagnosed DM patients from the Suntreso Government Hospital, who were on treatment for at least a year. A structured validated questionnaire was used to collect sociodemographic, lifestyle, and clinical data from the participants. Statistical analyses were performed using SPSS Version 20.0 and GraphPad Prism 8.0.ResultsMore than half (52.7%) of the study participants had poor knowledge of hypoglycemia. Moreover, 52.9% of diabetics had experienced hypoglycemia. Participants who were in the age groups of 55–64 and 65–80 years, being retired, being diagnosed with diabetes for 11–20 years and more than 20 years, taking in alcohol, and having adequate knowledge were independent determinants of experiencing hypoglycemia.ConclusionKnowledge level of hypoglycemia among Ghanaian diabetics is low. Prompt recognition of risk factors of hypoglycemia and the careful monitoring and management of glycemic levels in high‐risk groups are important to lessen the prevalence of hypoglycemia in these populations.

Drug-Induced Hypoglycemia in Neonates Born to Nondiabetic Women Treated with Medications during the Pregnancy or the Labor: A Systematic Review of the Literature.

The prompt identification of at-risk newborns for drug-induced hypoglycemia can minimize the risk for adverse side effects, inappropriate investigations, and considerable unnecessary costs. Existing literature discusses drug-induced hypoglycemia, but a systematic description of neonatal hypoglycemia induced or exacerbated by maternal medications is missing. We reviewed the association between neonatal hypoglycemia and maternal medications. We systematically searched the literature according to the PICOS model on drug-induced hypoglycemia in neonates born to nondiabetic women treated with medications during the pregnancy or the labor. The main outcomes of the review were: (1) prevalence of hypoglycemia, (2) risk factors and potential confounders, (3) time at onset and severity of hypoglycemia, (4) dose-response gradient, (5) metabolic features of hypoglycemia, (6) modalities to treat hypoglycemia, and (7) quality of the studies. We included 69 studies in this review and we identified 11 groups of maternal drugs related to neonatal hypoglycemia. Results were classified for each outcome. Our review aims at supporting clinicians in the identification of the newborn at risk for hypoglycemia and in the differential diagnosis of neonatal hypoglycemia. Further studies are necessary to assess the risk of neonatal hypoglycemia associated with common maternal medications. KEY POINTS: · A systematic description of neonatal hypoglycemia induced or exacerbated by maternal medications is missing.. · In our review we identified 11 groups of maternal drugs related to neonatal hypoglycemia.. · Our review aims at supporting clinicians in the identification of the newborn at risk for hypoglycemia..

THU276 The Use of Continuous Glucose Monitors for Management of Postbariatric Hypoglycemia

Abstract Disclosure: S. Jani: None. S. Bao: None. Postprandial hypoglycemia is a known complication of bariatric surgery. Mixed meal tolerance test performed in these patients often revealed hypoglycemia 1-3 hours after meals. Recent clinical studies using continuous glucose monitors (CGM) have shown the incidence of postbariatric hypoglycemia is much higher than previously identified. In addition to diet modification and medication treatment, CGM has become a more popular and useful tool in managing severe cases. We present a case of using CGM to manage postbariatric hypoglycemia. A 47 year old female with prior history of class 3 obesity treated with sleeve gastrectomy presented with hypoglycemia 2.5 years after her bariatric surgery. She complained of headache, anxiety, dizziness, and fatigue during a routine clinic visit, two hours after consuming a carbohydrate rich meal with simple sugars. Blood glucose was obtained and revealed severe hypoglycemia (glucose 38 mg/dL). This prompted an urgent referral to endocrinology. Review of glucose trends revealed multiple instances of postprandial hypoglycemia. Further labs suggested a low likelihood for insulinoma with no fasting hypoglycemia and HA1C normal at 5.3%. Postprandial hyperinsulinemic hypoglycemia was suspected clinically. Dietary modification with multiple small meals consisting of high protein, fiber and complex carbohydrates was recommended. Additionally, she was started on Libre 2 CGM for monitoring and prevention of severe hypoglycemia. Review of her CGM data during follow up visit demonstrated very low incidence of hypoglycemia and absence of severe hypoglycemia. Over time with continued use of her CGM and low incidence of hypoglycemia, she did not require medical therapy. Postprandial hypoglycemia after bariatric surgery can be severe and lead to disabling neuroglycopenic symptoms. With increased utilization of bariatric surgery, these postoperative complications will likely become more prevalent. In a Swedish nationwide study, the prevalence of postbariatric hypoglycemia was close to 0.2% in a cohort of 5040 patients. However, a more recent prospective study with a two-year observation of 333 patients after bariatric surgery using 2-hour glucose tolerance test revealed much higher prevalence of severe postprandial hypoglycemia (25.6%). Hypoglycemia was highest after gastric bypass surgery (32.6%), followed by sleeve gastrectomy (22.6%). Currently, there is no official guideline on utilization of CGM in management of hypoglycemia in nondiabetic patients. This case highlights the role of CGM in managing postbariatric hypoglycemia. CGM provides continuous glucose data, trends and alerts that can be a critical tool for patients to monitor, anticipate and prevent hypoglycemic events. Additionally, the real time data provided by CGM’s can help clinicians identify high risk patients who may benefit from the addition of medications to treat hypoglycemia. Presentation: Thursday, June 15, 2023

EPS8.06 Prevalence of hypoglycaemia, measured by flash glucose monitoring, after moderate intensity aerobic exercise in adults with cystic fibrosis, compared to healthy controls

EPS8.06 Prevalence of hypoglycaemia, measured by flash glucose monitoring, after moderate intensity aerobic exercise in adults with cystic fibrosis, compared to healthy controls

Unraveling, contributing factors to the severity of postprandial hypoglycemia after gastric bypass surgery.

Despite the increasing prevalence of postbariatric hypoglycemia (PBH), a late metabolic complication of bariatric surgery, our understanding of its diverse manifestations remains incomplete. To contrast parameters of glucose-insulin homeostasis in 2 distinct phenotypes of PBH (mild versus moderate hypoglycemia) based on nadir plasma glucose. University Hospital (Bern, Switzerland). Twenty-five subjects with PBH following gastric bypass surgery (age, 41 ± 12 years; body mass index, 28.1 ± 6.1kg/m2) received 75g of glucose with frequent blood sampling for glucose, insulin, C-peptide, and glucagon-like peptide 1 (GLP)-1. Based on nadir plasma glucose (</≥50mg/dL), subjects were grouped into level 1 (L1) and level 2 (L2) PBH groups. Beta-cell function (BCF), GLP-1 exposure (λ), beta-cell sensitivity to GLP-1 (π), potentiation of insulin secretion by GLP-1 (PI), first-pass hepatic insulin extraction (HE), insulin sensitivity (SI), and rate of glucose appearance (Ra) were calculated using an oral model of GLP-1 action coupled with the oral minimal model. Nadir glucose was 43.3 ± 6.0mg/dL (mean ± standard deviation) and 60.1 ± 9.1mg/dL in L2- and L1-PBH, respectively. Insulin exposure was significantly higher in L2 versus L1 (P = .004). Mathematical modeling revealed higher BCF in L2 versus L1 (34.3 versus 18.8 10-9∗min-1; P = .003). Despite an increased GLP-1 exposure in L2 compared to L1 PBH (50.7 versus 31.9pmol∗L-1∗min∗102; P = .021), no significant difference in PI was observed (P = .204). No significant differences were observed for HE, Ra, and SI. Our results suggest that higher insulin exposure in PBH patients with lower postprandial nadir glucose values mainly relate to a higher responsiveness to glucose, rather than GLP-1.