Assessment of the Magnitude, Severity and Associated Factors of Hypoglycemia in Diabetic Patients Attending National Diabetes Referral Clinic at Tikur Anbessa Hospital, Addis Ababa, Ethiopia

Wako, Abdinasir; Belay, Saba; Feleke, Yeweyenhareg; Kebede, Tedla

doi:10.4172/2155-6156.1000741

Cited by 7 publications

(7 citation statements)

References 12 publications

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“…Despite its significance, the odds of suffering episodes of hypoglycemia since they were diagnosed to have T1DM were about 35% less likely in male patients compared to female patients. This result was consistent with the finding documented in the study done in Ethiopia [32]. Physiologically, there is a large sexual dimorphism in counterregulatory responses to hypoglycemia.…”

Section: Discussionsupporting

confidence: 93%

“…Like other evidences, this finding described as history of diabetes and events of hypoglycemia went almost parallel in patients' life. Previous studies had demonstrated that patients with more than five years of diabetes history were more likely to experience hypoglycemia events [2, 5, 20, 32, 38]. Blood glucose monitoring options had also a significant association with the events of hypoglycemia.…”

Section: Discussionmentioning

confidence: 99%

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Evaluation of Hypoglycemia and Associated Factors among Patients with Type 1 Diabetes on Follow-Up Care at St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia

Kahsay

Fantahun

Nedi

et al. 2019

Journal of Diabetes Research

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Background. Hypoglycemia is one of the most common acute complications of type 1 diabetes mellitus (T1DM). The knowledge of the factors associated with hypoglycemia will help in the prevention and management of the problem. Therefore, this study was conducted to assess hypoglycemia and its associated factors among T1DM patients who attended the diabetes outpatient clinic of St. Paul’s Hospital Millennium Medical College (SPHMMC). Methods. A cross-sectional study was conducted at the diabetes clinic of SPHMMC. Data on sociodemographic and clinical characteristics including duration of diabetes, type of insulin they have been taking, the factors associated with hypoglycemia, and the severity stage of hypoglycemia was obtained. Data was collected using a structured questionnaire and chart review. Multivariate logistic regression model was used to identify factors associated with hypoglycemia. Result. Out of the 247 participants who were recruited into the study, 233 (94.3%) of them experienced hypoglycemia. A total of 6.9 events of hypoglycemia per patient per year happened. Particularly, the events were categorized as 3.1 mild events, 2.3 moderate events, and 0.93 severe events of hypoglycemia. Shorter duration of diabetes history (<1 year) was significantly associated with less experience of hypoglycemia (AOR=0.09, 95% CI: 0.01-0.90). However, blood glucose monitoring at home was found to be significantly associated with more report of hypoglycemia (AOR=5.77, 95% CI: 1.16-28.66). Conclusion. The prevalence of hypoglycemia among T1DM patients was found as substantially high. Self/family blood glucose monitoring at home could not guarantee to minimize the occurrence of hypoglycemia events. Finger stick home blood glucose monitoring should be given a special attention. Therefore, the involvement of health care providers in diabetes care should be encouraged to address the occurrence of hypoglycemia in T1DM patients.

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Section: Discussionsupporting

confidence: 93%

Section: Discussionmentioning

confidence: 99%

Evaluation of Hypoglycemia and Associated Factors among Patients with Type 1 Diabetes on Follow-Up Care at St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia

Kahsay

Fantahun

Nedi

et al. 2019

Journal of Diabetes Research

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“…This study was in line with 50% of the RECAP-DM study in Argentina (35). This finding was lower than 86.7% in Debre Markos Referral Hospital (5), 88% in Tikur Anbessa Specialized Hospital (23), and 94.3% in St. Paul's Hospital Millennium Medical College (22) studies in Ethiopia and 91.7% from HAT study in Brazil (36), 97.1% in Colombia (37), 97.4% from an international survey in nine countries (38), and 100% from the Southeast Asia cohort of IO HAT study (39). The variation observed between this and other studies may be due to the operational definition used.…”

Section: Discussionsupporting

confidence: 89%

“…The factors associated with hypoglycemia are varied. It may include age, sex, occupational status, residence, body mass index, missed meals or inadequate caloric intake, alcohol consumption, concurrent use of an opioid, level of fasting blood sugar, blood glucose monitoring, glucose checkup period, insulin or diabetes medications, duration of diabetes, and presence of stroke (3,5,8,(21)(22)(23)(24).…”

Section: Introductionmentioning

confidence: 99%

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

Yosef

2021

Front. Endocrinol.

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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.

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“…Hypoglycemia has a significant negative impact on a person’s well-being and QOL and can therefore influence adherence, compliance, and ultimately the success of the insulin therapy. In East Africa, surveys on hypoglycemia indicated high frequency episodes (T1DM, 88%; T2DM, 69%) with almost half of the study population being unaware of the hypoglycemia [ 144 ]. Efforts to avoid hypoglycemia include patient education, SMBG, and improving insulin delivery through proper delivery devices and techniques.…”

Section: Hypoglycemia Weight Gain and Psychosocial Aspectsmentioning

confidence: 99%

EADSG Guidelines: Insulin Therapy in Diabetes

et al. 2018

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Executive Summary and Recommendations A diagnosis of diabetes or hyperglycemia should be confirmed prior to ordering, dispensing, or administering insulin (A).Insulin is the primary treatment in all patients with type 1 diabetes mellitus (T1DM) (A).Typically, patients with T1DM will require initiation with multiple daily injections at the time of diagnosis. This is usually short-acting insulin or rapid-acting insulin analogue given 0 to 15 min before meals together with one or more daily separate injections of intermediate or long-acting insulin. Two or three premixed insulin injections per day may be used (A).The target glycated hemoglobin A1c (HbA1c) for all children with T1DM, including preschool children, is recommended to be < 7.5% (< 58 mmol/mol). The target is chosen aiming at minimizing hyperglycemia, severe hypoglycemia, hypoglycemic unawareness, and reducing the likelihood of development of long-term complications (B).For patients prone to glycemic variability, glycemic control is best evaluated by a combination of results with self-monitoring of blood glucose (SMBG) (B).Indications for exogenous insulin therapy in patients with type 2 diabetes mellitus (T2DM) include acute illness or surgery, pregnancy, glucose toxicity, contraindications to or failure to achieve goals with oral antidiabetic medications, and a need for flexible therapy (B).In T2DM patients, with regards to achieving glycemic goals, insulin is considered alone or in combination with oral agents when HbA1c is ≥ 7.5% (≥ 58 mmol/mol); and is essential for treatment in those with HbA1c ≥ 10% (≥ 86 mmol/mol), when diet, physical activity, and other antihyperglycemic agents have been optimally used (B).The preferred method of insulin initiation in T2DM is to begin by adding a long-acting (basal) insulin or once-daily premixed/co-formulation insulin or twice-daily premixed insulin, alone or in combination with glucagon-like peptide-1 receptor agonist (GLP-1 RA) or in combination with other oral antidiabetic drugs (OADs) (B).If the desired glucose targets are not met, rapid-acting or short-acting (bolus or prandial) insulin can be added at mealtime to control the expected postprandial raise in glucose. An insulin regimen should be adopted and individualized but should, to the extent possible, closely resemble a natural physiologic state and avoid, to the extent possible, wide fluctuating glucose levels (C).Blood glucose monitoring is an integral part of effective insulin therapy and should not be omitted in the patient’s care plan. Fasting plasma glucose (FPG) values should be used to titrate basal insulin, whereas both FPG and postprandial glucose (PPG) values should be used to titrate mealtime insulin (B).Metformin combined with insulin is associated with decreased weight gain, lower insulin dose, and less hypoglycemia when compared with insulin alone (C).Oral medications should not be abruptly discontinued when starting insulin therapy because of the risk of rebound hyperglycemia (D).Analogue insulin is as effective as human insulin but is a...

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Assessment of the Magnitude, Severity and Associated Factors of Hypoglycemia in Diabetic Patients Attending National Diabetes Referral Clinic at Tikur Anbessa Hospital, Addis Ababa, Ethiopia

Abstract: Background: Hypoglycemia poses a barrier to optimum diabetes management especially among patients taking insulin therapy. However little is known about the magnitude and effect of hypoglycemia among diabetic patients in Ethiopia.

Cited by 7 publications

References 12 publications

Evaluation of Hypoglycemia and Associated Factors among Patients with Type 1 Diabetes on Follow-Up Care at St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia

Evaluation of Hypoglycemia and Associated Factors among Patients with Type 1 Diabetes on Follow-Up Care at St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia

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

EADSG Guidelines: Insulin Therapy in Diabetes

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