Prevalence Of Hypoglycemia Research Articles

Hypoglycemia in Pregnancies Following Gastric Bypass-a Systematic Review and Meta-analysis.

The aims of this systematic review were to identify the prevalence of hypoglycemia among pregnant women treated with gastric bypass, and risk factors of hypoglycemic events in pregnancy. We searched MEDLINE, EMBASE, Cochrane, and Scopus databases from inception to April 6, 2021. Six studies investigating glucose metabolism in pregnancy following gastric bypass were included (n = 330). As assessed by the oral glucose tolerance test and continuous glucose monitoring, 57.6% (95% CI [40.1, 75.1]) of women with gastric bypass were exposed to hypoglycemia during pregnancy. No studies performed the mixed meal test, and no studies reported on risk factors associated with hypoglycemia. Further studies are required to determine the magnitude of hypoglycemia in these women's everyday-life using continuous glucose monitoring and mixed meal test.

Trends of severe hypoglycemia in patients with type 2 diabetes in Korea: A longitudinal nationwide cohort study.

To estimate the trends in the prevalence of severe hypoglycemia (SH) in patients with type 2 diabetes in Korea, we investigated the total number of SH episodes among type 2 diabetes patients aged ≥30 years who visited the emergency department between 2002 and 2019, using the Korean National Health Insurance Service database. The prevalence of SH events increased from 2002 to 2012; however, it has decreased gradually since 2012. In 2019, the prevalence of SH was 0.6%, with an incidence rate of 4.43 per 1,000 person‐years. Approximately 23,000 SH events occur every year in Korea. Although the incidence is steadily decreasing, there are a considerable number of SH events in type 2 diabetes patients. The decline in the incidence of SH seems to most likely be due to the increased prescription rate of hypoglycemic agents without hypoglycemia risk, less‐strict treatment goals and the individualization of therapy.

Efficacy of education on injection technique for patients diagnosed with diabetes with lipohypertrophy: systematic review and meta-analysis

ObjectivesThis study aimed to investigate the efficacy of providing education on injection technique to patients with diabetes with lipohypertrophy (LH).DesignWe conducted a systematic review and meta-analysis.MethodsWe included patients with diabetes...

The management of diabetic ketoacidosis in adults-An updated guideline from the Joint British Diabetes Society for Inpatient Care.

This article summarises the Joint British Diabetes Societies for Inpatient Care guidelines on the management of ketoacidosis; available at https://abcd.care/resource/management-diabetic-ketoacidosis-dka-adults. The document explicitly states that when a person aged 16-18 is under the care of the paediatric team, then the paediatric guideline should be used, and if they are cared for by an adult team, then this guideline should be used. The guideline takes into account new evidence on the use of the previous version of this document, particularly the high prevalence of hypoglycaemia and hypokalaemia, and recommends that when the glucose concentration drops below 14mmol/L, that de-escalating the insulin infusion rate from 0.1 to 0.05units/kg/h should be considered. Furthermore, a section has been added to address the recognition that use of sodium glucose co-transporter 2 inhibitors is associated with an increased risk of euglycaemic ketoacidosis. The management of ketoacidosis in people with end-stage renal failure or on dialysis is also mentioned. Finally, the algorithms to illustrate the guideline have been updated.

A view at postbariatric hypoglycemia by endocrinologist

The obesity epidemic has led to the growing number of bariatric operations and the expansion of indications for this operation as the most effective method of treatment, that’s why endocrinologists are increasingly faced the challenge of late complications, including postbariatric hypoglycemia. Postbariatric hypoglycemia is a rare but severe metabolic disorder that occurs months or years after upper gastrointestinal surgery. Postbariatric hypoglycemia can be accompanied by severe clinical symptoms and lead to disability and decreasing of the life’s quality. It is difficult to assess the prevalence of hypoglycemia after bariatric surgery due to the lack of clear diagnostic criteria, often a hidden clinical picture and ignorance of doctors and patients about this complication. Hypoglycemia in this case has postprandial and hyperinsulinemic nature. The mechanisms of development of this complication have recently been actively discussed. The exchange of incretins and dysregulation of insulin secretion are the subject of constant research in this area. Understanding the mechanisms of development of this condition makes it possible to develop optimal methods of diagnosis and treatment. The issues of pathophysiology, basic principles of diagnosis and treatment of post-bariatric hypoglycemia will be considered in this review.

The Effect of Various Pre-Cesarean Fasting Times on Maternal and Neonatal Outcomes.

Although it is currently recommended that patients avoid solid food for 6-8 h and liquid for 2 h before cesarean section, longer restrictions still apply in many centers. Since studies on the duration of fasting before cesarean section is scarce, we aimed to investigate the effect of different fasting times before cesarean section on maternal and neonatal complications. This descriptive study was performed on 405 candidates for cesarean section. These women were divided into five groups due to the length of time they did not consume clear liquid and solid food. Then, maternal and neonatal outcomes were compared using Kruskal-Wallis and Chi-square tests. The rate of nausea during surgery was lower in the groups who ate solid food between 2 and 8 h and clear liquid <2 h before surgery (P = 0.04). Also, abdominal distension in the first 6 h after surgery in the group that did not eat solid food for <6-8 h and clear liquid for <2 h was more than in the other groups (P < 0.05). The prevalence of hypoglycemia was significantly lower in women who ate solid food for <6 h and drank clear liquid for <2 h (P < 0.05). Prolonged fasting time before cesarean section not only reduce complications but also may have undesirable consequences. The results of this study showed that it is better to use less strict measures in patients who are candidates for cesarean section and in patients with labor pains who are likely to have a cesarean section.

Residual insulin secretion and management of type 1 diabetes: Interest of new C-peptide assays

Plasma C-peptide represents a direct measure of endogenous insulin secretion. The development of new assays for measuring C-peptide have made it possible to demonstrate that a low insulin secretion persists in 30 to 80% of subjects with type 1 diabetes (T1D), even among those with long-standing disease. Several studies have established that the persistence of B cell function of the islets of Langerhans is associated with a protection against the development of microvascular complications and resulted in a significant reduction in the prevalence of severe hypoglycaemia in people with T1D. Further studies are needed to clarify the underlying pathophysiological mechanisms and the therapeutic strategies that would maintain B-cell function and thus improve the quality of life of patients with T1D.

Frequency of Hypoglycemia in Preterm Newborns

Objective: The purpose of this study is to determine the prevalence of hypoglycemia and its increased risk of morbidity and mortality in preterm newborns. Study Design: Cross-sectional Place and Duration: Study was conducted at Children Medical Center (CMC) / Dr Habib un Nabi Children Hospital Airport Road Mingora Swat and Memon Medical Institute Karachi for duration of six months from January 2021 to June 2021. Methods: Total 120 preterm neonates had symptomatic and asymptomatic hypoglycemia was presented in this study. Detailed demographics included sex, birth weight and gestational age were recorded after taking informed written consent from the authorities. Blood sample was taken from all neonates for laboratory test. Blood glucose &lt;40mg/dl were calculated as hypoglycemia. Frequency of hypoglycemia and its risk factors with symptoms were calculated in this study. SPSS 22.0 version was used to analyze all data. Results: Majority of the infants were males 75 (62.5%) and 45 (37.5%) were females. Mean gestational age was 32.3+6.37 weeks. Mean birth weight of the infants was 2.04±3.43 kg with mean age 4.5+3.73 days. Out of 120 cases, 88 (73.3%) neonates were born by C-section. Frequency of hypoglycemia was fund among 52 (43.3%) cases in which majority were males with symptomatic hypoglycemia in 40 (33.3%) neonates. Hypertension in mothers was the most common cause of hypoglycemia found in 27 (51.9%) cases. Breast feeding difficulty was the most common symptom in 43 (82.7%) cases followed by jitteriness in 32 (61.5%). Rate of mortality was 7 (13.5%). Conclusion: In this research we concluded that the prevalence of hypoglycemia was significantly higher in preterm neonates and maximum cases were reported in symptomatic neonates with higher number of males. For children, hypoglycemia is associated with a high mortality risk. If a child's blood sugar levels go dangerously low or if they've been fasting for an extended period of time, they should receive treatment. Keywords: Preterm Newborns, Hypoglycemia, Prevalence, Mortality, Symptoms

Hypoglycaemia among adults with Type 2 Diabetes mellitus in a Family Medicine Clinic

Background: The prevalence of Diabetes mellitus (DM) is increasing worldwide. The complications of DM arising from hyperglycaemia are well documented and. However, there is a lack of data, poor awareness and information on hypoglycaemia in DM.&#x0D; Objective: To describe the prevalence and factors associated with hypoglycaemia among patients with Type 2 Diabetes mellitus (DM).&#x0D; Methods: This was a retrospective study of the clinical records of patients with Type 2 DM at the Family Medicine Clinic of a Nigerian teaching hospital from January 2019 to January 2020. The sociodemographic and clinical characteristics, including hypoglycaemia, Glycosylated Haemoglobin (HbA1c), Fasting and Random blood glucose, were retrieved.&#x0D; Results: A total number of 570 patients were assessed, with a prevalence of 43 (7.5%) of hypoglycaemia. The mean age of the patients in the study was 58.2±10.9 years (range: 36-83 years). Metformin (557; 97.7%), Sulphonylureas (377; 66.1%), Dipeptidylpeptidase -4 inhibitors (137; 24.0%) and insulin (72; 12.6%) were the most prescribed anti-diabetic medications. hypoglycaemiaA majority (29; 67.4%) of the hypoglycaemia episodes occurred in the morning, while most (24; 55.8%) of the episodes of hypoglycaemia were mild. Mean age (t= 2.35; p = 0.019), presence of hypertension (X2 = 6.92, p = 0.008) and dyslipidaemia (X2 = 7.86, p = 0.005) were associated with hypoglycaemia.&#x0D; Conclusions: The prevalence of hypoglycaemia in the Outpatient clinic was low, while the presence of comorbidities (hypertension and dyslipidaemia) and age were associated with hypoglycaemia. There is a need for patient education and Self-Monitoring of Blood Glucose (SMBG) to prevent complications of hypoglycaemia. hypoglycaemia

Recent Advances in Insulin Delivery Devices and Modes of Insulin Therapy

The discovery of insulin was 100 years old till 2021. Insulin, the first diabetic medication, is now the safest and most effective glucose-lowering medication available. Despite its efficacy, the most significant challenge with insulin has been the prevalence of hypoglycemia, which has resulted in the majority of patients being prescribed optimum dosages. Insulin delivery devices include syringes, pens, and pumps. Soon, artificial pancreas (AP) by using a very closed-loop delivery method will be a big step towards the advancement of insulin delivery devices. This article looks at the invention of syringes, disposable, long-lasting pens, and smart connected pens, continuous intraperitoneal insulin infusion (CIPII) and patch insulin pumps, artificial pancreas and other medical devices. Hence, insulin administration that is both minimally invasive and non-invasive towards the advancement is required. We review the available information on the evolution of insulin delivery systems, focusing on the advantages and disadvantages of technology as well as anticipated advances. Due to the wide variety of technological solutions accessible via the international platform, only the most common methods essential to the patient’s care are detailed here in the article.

Prevalence of Post–Glucose Challenge Hypoglycemia in Adult Patients With Cystic Fibrosis and Relevance to the Risk of Cystic Fibrosis–Related Diabetes

ObjectivesThe clinical relevance of fasting and postprandial hypoglycemia in patients with cystic fibrosis (CF) is poorly characterized. Our aim in this study was to characterize the prevalence of hypoglycemia in adult patients during oral glucose tolerance test (OGTT) screening and determine its impact on the risk of developing CF-related diabetes (CFRD). MethodsWe analyzed 2 cohorts of pancreatic insufficient patients with CF exposed to comparable treatment recommendations in France (Lyon CF cohort [DIAMUCO]) and Canada (Montréal CF cohort [MCFC]). Patients were classified into 3 groups based on hypoglycemia absence or presence as well as its severity at baseline. We defined the groups as follows: level 2 hypoglycemia (L2H; plasma glucose [PG]<3.0 mmol/L), level 1 hypoglycemia (L1H; PG 3.0 to <4.0 mmol/L) and no hypoglycemia (NH) during an OGTT. ResultsA total of 153 MCFC and 114 DIAMUCO subjects were included in the study. In total, 22% of the patients experienced hypoglycemia, with 5% having it on 2 or more OGTTs. The L1H and L2H groups tended to have a lower 2-hour glucose and higher early-phase insulin secretion (insulin area under the curve at 0 to 30 minutes) compared with NH patients. In both cohorts, a greater proportion of men and patients with normal glucose tolerance had hypoglycemia. Over a 5-year period, there were no cases of CFRD in the L2H group, whereas 4 subjects in the L1H group and 36 in the NH group developed CFRD. ConclusionsPatients with hypoglycemia were at lower risk of developing CFRD, but at higher risk of early-phase insulin secretion and unsuppressed insulin secretion. This could potentially lead to further hypoglycemia after the 2-hour OGTT, suggesting high clinical relevance.

Blood Sugar Changes in Patients with Acute Drug Poisoning

Changes in blood sugar in poisoning can be one of the most important determinants of the outcome of patients with poisoning. Since poisoning is one of the most common and increasing causes of death worldwide and one of the most critical medical emergencies, this study aimed to investigate changes in blood sugar in patients with acute poisoning and how patients' blood sugar can predict the severity and outcome of the disease. The present study was performed on 200 patients with acute drug poisoning referred to the emergency department of Amir Al-Momenin Hospital in Zabol from March 2018 to March 2020. Blood glucose levels of all patients were recorded at the time of admission and every hour to the first 5 hours after admission, and the results were entered in the information form of each patient. Finally, the data were entered into SPSS V22 software and statistically analyzed. The mean age of participants was 23.21 ± 12.80 years, and the minimum and maximum age of patients were 1 year and 77 years, respectively, and only 9.8% of them had a history of diabetes. In this study, the highest rate of intoxication with opioids such as methadone and tramadol was (38%), followed by benzodiazepines (20.5%), NSAIDs (19.5%), and SSRIs (7%) were the most commonly used drugs. The prevalence of hypoglycemia in this study was 3% (6 patients), while no cases of hyperglycemia were reported. In this study, most changes in blood sugar were caused by alcohol poisoning. Also, neuroleptics, NSAIDs, and chemicals had the least changes in blood sugar. However, patients' blood sugar at the beginning of poisoning did not affect patients' prognosis. The present study results showed that changes in blood sugar during treatment during drug intoxication, alcohol, medications(sulfonylurea, glibenclamide), and NSAID are very important, so regular monitoring of blood glucose in intoxication with these cases is essential.

Novel approaches to hypoglycemia and burnt-out diabetes in chronic kidney disease.

Diabetes mellitus is a leading cause of chronic kidney disease (CKD) that confers faster kidney disease progression, higher mortality, and various metabolic derangements including hypoglycemia. Even in the absence of diabetes mellitus, growing research demonstrates that CKD patients are at heightened risk for hypoglycemia via multiple pathways. In CKD patients transitioning to end-stage renal disease (ESRD), spontaneous resolution of hyperglycemia and frequent hypoglycemia resulting in reduction and/or cessation of glucose-lowering medications are frequently observed in a phenomenon described as 'burnt-out diabetes'. In non-CKD patients, it is well established that hypoglycemia is causally associated with mortality, with pathways including arrhythmias, sudden cardiac death, stroke, and seizures. Increasing evidence shows that, in CKD and ESRD patients with and without diabetes mellitus, hypoglycemia is associated with cardiovascular complications and mortality risk. Given the high prevalence of hypoglycemia in CKD patients and the morbidity and mortality associated with this metabolic complication, a multimodal strategy is needed to prevent dysglycemia, including individualization of glycemic targets, selection of glucose-lowering medications less likely to induce hypoglycemia, medical nutrition therapy administered by trained dietitians, and accurate and precise hypoglycemia detection methods, such as self-monitored blood glucose or continuous glucose monitoring including during dialysis treatment.

Prevalence of Post-Glucose Challenge Hypoglycemia in Adult Patients with Cystic Fibrosis and Relevance to the Risk of Cystic Fibrosis–Related Diabetes

The clinical relevance of fasting and post-prandial hypoglycemia in patients with cystic fibrosis (CF) is poorly characterized. Our aim was to characterize the prevalence of hypoglycemia in adult patients during oral glucose tolerance test (OGTT) screening and determine its impact on the risk of developing CF-related diabetes (CFRD).

Spontaneous and iatrogenic hypoglycemia in cystic fibrosis

Spontaneous episodes of hypoglycemia can occur in people with cystic fibrosis (CF) without diabetes, who are not on glucose lowering medications. Spontaneous hypoglycemia in CF could occur both in the fasting or postprandial state (reactive hypoglycemia). The pathophysiology of fasting hypoglycemia is thought to be related to malnutrition and increased energy expenditure in the setting of inflammation and acute infections. Reactive hypoglycemia is thought to be due to impaired first phase insulin release in response to a glucose load, followed by a delayed and extended second phase insulin secretion; ineffective counterregulatory response to dropping glucose levels may also play a role. The overall prevalence of spontaneous hypoglycemia varies from 7 to 69% as examined with oral glucose tolerance test (OGTT) or with continuous glucose monitoring (CGM) under free living conditions. Spontaneous hypoglycemia in CF is associated with worse lung function, higher hospitalization rates, and worse clinical status. In addition, patients with CF related diabetes on glucose-lowering therapies are at risk for iatrogenic hypoglycemia. In this article, we will review the pathophysiology, prevalence, risk factors, clinical implications, and management of spontaneous and iatrogenic hypoglycemia in patients with CF.

Glycemic control and neonatal outcomes in women with gestational diabetes mellitus treated using glyburide, metformin, or insulin: a pairwise and network meta-analysis

AimsWe aimed to assess the comparative efficiency and safety of the use of glyburide, metformin, and insulin in gestational diabetes mellitus (GDM).MethodsWe searched for randomized controlled trials that compared glyburide, metformin, and insulin in GDM. Data regarding glycemic control and neonatal safety were collected and analyzed in pairwise and network meta-analyses.ResultsA total of 4533 individuals from 23 trials were included. Compared with glyburide, metformin reduced 2-h postprandial blood glucose (2HPG) to a greater extent (standard mean difference (SMD) 0.18; 95% credible interval (CI) 0.01, 0.34). There were significantly lower prevalence of neonatal hypoglycemia (risk difference (RD) − 0.07; 95%CI − 0.11, − 0.02) and preeclampsia (RD − 0.03; 95%CI − 0.06, 0) in the metformin group than in the insulin group. The metformin group had significantly lower birth weight (SMD − 0.17; 95%CI − 0.25, − 0.08) and maternal weight gain (SMD − 0.61; 95%CI − 0.86,− 0.35) compared with the insulin group. Network meta-analysis suggested that metformin had the highest probability of successfully controlling glycemia and preventing neonatal complications.ConclusionsThe present meta-analysis suggests that metformin may be as effective as insulin for glycemic control and is the most promising drug for the prevention of neonatal and maternal complications.

Hypoglycemia Among Type 1 Diabetes Patients After Insulin Use in Southwest Ethiopia.

IntroductionGlycemic control is a valuable goal for people with diabetes; however, the greatest challenge to achieving tight glycemic control is hypoglycemia. Hypoglycemic events are probably common in type 1 diabetes; however, little is known about hypoglycemia in Ethiopia. Therefore, this study aimed to assess the prevalence and the associated factors of hypoglycemia among type 1 diabetes (T1D) patients after insulin use at Metu Karl Referral Hospital in southwest Ethiopia.Materials and MethodsA hospital-based cross-sectional study was conducted among 242 T1D patients at Metu Karl Referral Hospital in southwest Ethiopia. The prevalence of hypoglycemia was assessed by a structured questionnaire through a face-to-face interview in which all the possible symptoms of hypoglycemia were included. If the patients reported that they had experienced the symptoms at least two times in a month and the symptoms were relieved upon consuming sugar/candy/honey, such cases were considered to have had a hypoglycemic episode. Binary logistic regression analysis was done to identify the factors associated with the occurrence of hypoglycemia.ResultsOut of 242 T1D patients interviewed, 114 (47.1%) had self-reported hypoglycemia. The most reported symptom of hypoglycemia was sweating (91.7%), followed by dizziness and hunger and nausea with a prevalence of 24.8 and 14.5%, respectively. The study also found that educational level with reading and writing skills up to primary level [adjusted odds ratio, AOR = 0.41; 95% confidence interval, CI (0.19–0.88)] and secondary level and above [AOR = 0.32, 95% CI (0.14–0.70)], poor knowledge of diabetes [AOR = 2.26, 95% CI (1.06–4.84)], good knowledge of insulin self-administration [AOR = 0.54, 95% CI (0.30–0.99)], and duration of insulin use ≥5 years [AOR = 3.93, 95% CI (1.44–10.7)] were factors associated with hypoglycemia.ConclusionsThe prevalence of hypoglycemia was found remarkable. We can conclude that hypoglycemia is of public health importance among T1D patients. Since the study assesses hypoglycemia after insulin injection, this prevalence may be due to the poor practice of insulin injection. Therefore, imparting education on the proper technique of insulin administration should be considered at each follow-up visit.

Efficacy of standard- vs reduced-dose insulin for treatment of hyperkalemia: A quasi-experiment.

DisclaimerIn an effort to expedite the publication of articles related to the COVID-19 pandemic, AJHP is posting these manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time.PurposeHyperkalemia more commonly affects patients with a glomerular filtration rate of less than 60 mL/min. Using intravenous (IV) insulin to shift potassium intracellularly may cause hypoglycemia, requiring additional treatment or longer hospitalization. Literature on insulin dosing in this context is limited, with one previous study indicating that 5 units of IV insulin might be as effective and result in less hypoglycemia than the standard dose of 10 units of IV insulin. The hyperkalemia treatment pathway at our institution was revised in May 2018 to include a reduced-dose option (5 units of insulin) for patients with end-stage renal disease. This study aimed to compare the prevalence of hypoglycemia between patients who received standard-dose vs reduced-dose IV insulin.MethodsThis single-center, retrospective, quasi-experimental study evaluated the impact of revision of the hyperkalemia treatment pathway by assessing rates of hypoglycemia during the 6 months before and after implementation of the revised pathway. The primary endpoint was prevalence of hypoglycemia, defined as a blood glucose level of less than or equal to 70 mg/dL.ResultsThere was no statistically significant difference in the occurrence of hypoglycemia when comparing the pre- and postimplementation groups (36 [17.7%] patients vs 34 [18.7%] patients; P = 0.7924). The postimplementation group had a statistically significant lower reduction in potassium levels after treatment than the preimplementation group (mean [interquartile range], –0.9 [–1.3, –0.5] mEq/L vs –0.6 [–1.2, –0.2] mEq/L; P = 0.0095). Baseline potassium levels were similar between the groups.ConclusionAdministration of reduced-dose IV insulin for treatment of hyperkalemia was significantly less effective in lowering serum potassium levels and did not decrease prevalence of hypoglycemia. When accounting for potential confounders, the only variable that was associated with hypoglycemia was pretreatment glucose level.

New Options to Simplify the Treatment of Severe Hypoglycemia in Long-Term Care

New Options to Simplify the Treatment of Severe Hypoglycemia in Long-Term Care

Nocturnal hypoglycemia in type 1 and type 2 diabetes: an update on prevalence, prevention, pathophysiology and patient awareness

ABSTRACT Introduction Despite considerable progress in diabetes treatment, prevalence of nocturnal hypoglycemia in type 1 diabetes mellitus (T1DM) and advanced insulin treated type 2 diabetes mellitus (T2DM) remains high. Areas covered The present manuscript describes the prevalence of night-time hypoglycemia as reported in observational and randomized controlled trials. Factors that affect the risk of hypoglycemia are highlighted. The authors also describe impaired awareness of hypoglycemia and available preventive methods. Expert opinion Prevention of nocturnal hypoglycemia includes behavioral, dietary and pharmacologic interventions. The most recent development with the lowest rate of hypoglycemia is sensor-augmented pumps with predictive low glucose suspend technology. These pumps combine continuous subcutaneous insulin infusion with continuous glucose monitoring and use various algorithms to predict and stop hypoglycemia before it develops.