Severe Hypoglycemia and Short-Term Mortality in Type 2 Diabetes

This article is part of Endocrinology Advisor‘s coverage of the 26th American Association of Clinical Endocrinologists (AACE) Annual Scientific Sessions & Clinical Congress, taking place in Austin, Texas. Our staff will report on medical research and technological advances in diabetes, obesity, and thyroid conditions, conducted by experts in the field. Check back regularly for more news from AACE 2017.

A recent prospective study demonstrated that the majority of patients with diabetes requiring hospitalization for severe hypoglycemia were patients with type 2 diabetes.¹

The results were presented at the 26th American Association of Clinical Endocrinologists (AACE) Annual Scientific Sessions & Clinical Congress, May 3-7, in Austin, Texas.

Noting a lack of data regarding short-term mortality in these patients, researchers from Sarojini Naidu Medical College in Agra, India, investigated this outcome and associated clinical characteristics and risk factors. The sample included 50 patients with diabetes who presented to the hospital with altered consciousness and plasma glucose ≤70 mg/dl. Patients with malignancies, acute cerebrovascular events, symptomatic congestive heart failure, or an estimated glomerular filtration rate (eGFR) <10 were excluded from the study.

According to the findings, total in-hospital mortality was 4% (n=2), and 90-day all-cause mortality was 8% (n=4). Of all hypoglycemia episodes, 82% occurred in patients with type 2 diabetes, and all 4 deaths occurred in that patient group.

The following clinical and patient characteristics were also observed:

• Medication information: 17 patients were on a single medication (sulfonylurea or insulin), 19 were on 2 medications, and 14 were on ≥3 medications; the most commonly prescribed medication was sulfonylurea, which 32 patients were taking
• Severe hypoglycemia in patients with type 2 diabetes was strongly associated with sulfonylurea and metformin combination therapy (78%)
• The mean age of patients with type 1 diabetes was 31.77±8.9 vs 65.97±10.5 in patients with type 2 diabetes
• The mean plasma glucose of the entire population was 36.62±11.57 mg/dL, and mean glycated hemoglobin was 8.58±1.94%
• The mean creatinine clearance was 55.83±26.5, and 64% of patients had a creatinine clearance <60 ml/min/1.73 m²
• A total of 14 patients were previously admitted to the hospital for hypoglycemia
• More than half of patients were illiterate or uninformed about hypoglycemia

Taken together, these results suggest that “severe hypoglycemia is an important risk factor for [a] short-term increase in all-cause mortality, particularly in [patients with] type 2 diabetes,” the researchers concluded.

The finding of creatinine clearance <60 in a high percentage of patients points to impaired renal function as a potential contributing factor.

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Reference

Tak S, Jain A, Lakhotia M. Severe hypoglycemia in type 2 diabetics requiring hospitalisation and short term mortality. Abstract 315. Presented at: 26th American Association of Clinical Endocrinologists Annual Scientific Sessions & Clinical Congress. May 3-7, 2017, Austin, TX.