Study of Oral Hypoglycemic Agent-induced Hypoglycemia in Type 2 Diabetes Mellitus in a Tertiary Care Center

Diabetes prevalence is increasing rapidly; estimates from the International Diabetes Federation put the number at 381 million people have diabetes. Hypoglycemia is a commonly encountered complication in diabetic patients, which, in the short-term, can lead to mortality and, in the long-term, precludes maintenance of euglycemic control. Over 65.2 % of patients have reported at least one incidence of severe and nonsevere hypoglycemia when on oral hypoglycemic agents (OHA) at an annual crude incidence density of 35.1 events per year per person. Insulin more commonly causes hypoglycemia than OHA. However, this study was done with the aim of studying the hypoglycemia specifically caused by OHAs-clinical profile of patients, medications causing hypoglycemia, and the outcome.

This prospective observational study was conducted in the Department of Medicine at a tertiary care hospital in Western Maharashtra. Data was collected over a period of 18 months from Indoor patients on admission having hypoglycemic symptoms with strip blood sugar levels of <70 and on OHAs. Patients on insulin were excluded from the study.

There were 60 patients with hypoglycemia with a mean age of 53.65 years and a higher incidence of hypoglycemia in females, 35 (58.3%) compared to males. There was a statistically significant difference between outcome (i.e., discharged or death) and urine protein-creatinine ratio (UPCR), a deranged liver function, that is, serum albumin, serum glutamic oxaloacetic transaminase (SGOT)/aspartate transaminase, and serum glutamic pyruvic transaminase (SGPT)/alanine transaminase (p < 0.05). However, there was no statistically significant difference between outcome (discharged or death) and mean age, gender, mean duration of diabetes mellitus (DM), GCS scoring, and drug type of study subjects (p > 0.05).

The risk factors for hypoglycemia were middle-aged patients. Females are at higher risk of hypoglycemia than men. Hypoglycemia due to OHAs is known to have a recurrence of hypoglycemia due to the long half-life of the drug; however, patients who were hospitalized were well monitored and did not have any recurrence of hypoglycemia. Deranged liver function or raised UPCR have high mortality after OHA-induced hypoglycemia.