A Comparative Multicenter Cross-Sectional Study on Hypoglycemia in Young Adults and Older Adults With Type 2 Diabetes Mellitus in an Outpatient Setting in Sri Lanka.

Background

Hypoglycemia has been an often-neglected complication of diabetes therapy. Mild hypoglycemia reduces quality of life, while severe hypoglycemia is life-threatening and can precipitate major cardiovascular and cerebrovascular events.

Methods

A multicenter cross-sectional study was conducted on hypoglycemia among adults with diabetes attending 19 medical clinics in government hospitals in Sri Lanka using an interviewer-administered questionnaire.

Results

There were 2005 participants, and 1110 (55.4%) were < 65 years of age and 895 (44.6%) were > 65 years of age; the mean age was 62.12 ± 11.94 years (58.1% female). The median duration of diabetes was 8 (IQR11) years. Among them, 808 (43%), 757 (37.8%), and 376 (18.8%) had neuropathy, retinopathy, and nephropathy, respectively, while 415 (20.7%), 50 (2.5%), and 22 (1%) had ischemic heart disease, strokes, and peripheral vascular disease, respectively. One thousand three hundred forty-nine (67.3%) experienced at least one episode of hypoglycemia, and 462 (34.2%) had hospital admissions (9 (0.7%) intensive care admissions) over the past year. Older adults (n = 584) experienced significantly more symptomatic hypoglycemia compared to the younger population (p ≤ 0.001). Their mean CBS during hypoglycemic episodes was 57.04 ± 18.15 mg/dL. Among them, 1552 (77.4%) were on oral hypoglycemic medications, 453 (22.6%) were on insulin, and 126 (6.3%) were on both. The most typical reasons for hypoglycemia were skipping meals while taking regular medications (511, 37.9%), consumption of sugar-reducing native food items (203, 15%) and taking higher doses of insulin (112, 8.3%) and oral medication (74, 5.5%) than prescribed. To self-manage hypoglycemia, 1070 (79.3%) took sugary drinks, food, or glucose, and 279 (20.7%) did not do anything. There were 304 (34%) frail older adults, and 238 (78.3%) got hypoglycemia. They were taking similar prescriptions as young adults. They displayed significant hypoglycemic symptoms such as dizziness, irritability, nausea, speech impediment, and blurred vision compared to nonfrail elders (p ≤ 0.01). There were 485 diabetic patients who either drove or rode in a vehicle; 51 (10.5%) of them had experienced hypoglycemia during driving or riding.

Conclusion

Hypoglycemia is a significant issue which needs to be addressed. There is no difference in prescription medication in age categories and frail patients. Driving and hypoglycemia are also a concerning issue. Patients need advice on the prevention and treatment of hypoglycemia.