Risk Factors of Severe Hypoglycemia in Type 2 Diabetic Patients at District Hospital, Wiang Pa Pao Chiang Rai, Thailand

Abstract

Background: The incidence of hypoglycemia in diabetic patients in District Hospital Wiang Pa Pao, Chiang Rai increases every year. Hypoglycemia is very common in the emergency room, which potentially causes morbidity and mortality in these patients. Hypoglycemia causes limitation in the treatment of diabetes and subsequent glucose control. Therefore, this research attempted to identify the main factors associated with this hypoglycemic syndrome of type 2 diabetic patients in Wiang Pa Pao district, Chiang Rai province. It is anticipated that this information can be used to plan for treatment and prevention. Objective: The objective of this study is to identify the main factors associated with hypoglycemic episodes in type 2 diabetic patients receiving health care at Wiang Pa Pao hospital, Chiang Rai during 2018 - 2020. Methods: The design is a case control study in type 2 diabetic patients who received treatment at Wiang Pa Pao Hospital, Chiang Rai during 2018 - 2020. The number of cases and controls were 59 and 236 respectively. Data collection was obtained from the patient hospital information system including gender, occupation, weight, height, age, body mass index (BMI), HbA1c, eGFR, total cholesterol, diabetic medications, and comorbid diseases. Analytical statistics used in this study was univariable logistic regression described in odd ratio and statistical significance P-valve < 0.05. Results: This study found that the factors associated with hypoglycemic syndrome in type 2 diabetic patients were BMI, HbA1C level and type of diabetic medications. In BMI of 18.5 - 22.9 kg/m², patients had a risk of developing hypoglycemia more than patients who had BMI 23 kg/m² (P-value 0.02, OR 2.51). In BMI below 18.5 kg/m2, patients had a risk of developing hypoglycemia more than patients who had BMI 23 kg/m² (P-value < 0.0001,OR 7.14). This research also found that for the HbA1C 10.1% - 13% there was a risk for hypoglycemic episodes more than HbA1C 4 % - 7% (P-value 0.02, OR 2.14). Finally, this research found that the patients who used insulin treatment had a higher chance of developing hypoglycemic episodes compared to the patients who used oral anti-diabetic drugs alone (P-valve < 0.0001, OR 27.26) and patients who used both oral anti-diabetic agents and insulin, had a higher risk of developing hypoglycemic syndrome more than patients who used oral medications alone. (P-value < 0.0001, OR 3.95). Conclusion: The study found that the level of HbA1c had an association with hypoglycemia in type 2 diabetic patients. The higher initial HbA1c level, the greater the chance of having the hypoglycemic episode. Additionally, patients who had low body mass index were at increased risk of hypoglycemia. The type of anti-diabetic medications also had an effect. Patients who used only insulin injection and patients who used combination of insulin and oral agents, had a higher risk of hypoglycemia than patients who used oral medication alone.