Title: A study of hypoglycemia in type 2 diabetes mellitus patients using continuous glucose monitoring system

Authors: Dr M Sasi Sekhar, Dr Prabhakar K, Dr Anitha A

 DOI: https://dx.doi.org/10.18535/jmscr/v8i11.30

Abstract

The study was conducted with the objectives to assess the proportion of occurrence of hypoglycaemia, its episodes and to find the correlation between HbA1c and hypoglycemia among the subjects with type 2 diabetes mellitus subjects.

Methodology: This is a cross-sectional study conducted among a total of 50 subjects for a period of 18 months. Considering the inclusion and exclusion criteria, with basic data collection, all the study subjects were subjected to Continuous Glucose Monitoring using FREESTYLE LIBRE PRO approved by FDA. The data was collected for a whole 24 hour period and a series of such data was collected for 14 days and was expressed in means and proportions. Correlation was elicited using Pearson’s Correlation test. The analysis was done by SPSS version 16.0. A P value of <0.05 was taken as statistically significant

Results: Mean age of the study subjects was 54.78 + 9.49 years. Majority i.e., Seventy percent (70.0%) were males and Seventy Two percent (72.0%) were on oral hypoglycaemic agents. Sixteen percent (16.0%) gave history of previous hypoglycaemia. Thirty Two (32.0%) had atleast 1 episode of hypoglycaemia (Mean of 1.1 episodes/patient/14 days of CGMS) and more than Fifty (50.0%) of those had severe hypoglycaemia. Levels of HbA1c with the occurrence of hypoglycaemia and mean number of episodes of hypoglycemia showed a negative correlation however it was significant with mean number of episodes (P<0.05).

Conclusion: The occurrence of hypoglycaemia with decreasing levels of HbA1c indicates the strict therapeutic management. Previous history of hypoglycaemia is an indicator for further hypoglycaemia occurrence and has to be taken into account during the follow up of such cases.

Keywords: Hypoglycaemia, Continuous glucose monitoring, Type 2 diabetes mellitus, freestyle libre pro

References

  1. International Diabetes Federation. IDF Diabetes Atlas, 8th edn. Brussels, Belgium: International Diabetes Federation 2017.[cited on 2018 Jun 9]. Available from: http://www.diabetesatlas.org
  2. Prevalence of Diabetes in India. 2015. [cited on 2018 Jun 9].Available from: (https://www.mapsofindia.com/my-india/india/prevalence-of-diabetes-in-india)
  3. Unnikrishnan R, Anjana RM, Mohan V. Diabetes mellitus and its complications in India. Nature Reviews Endocrinology. 2016 Jun;12(6):357-70.
  4. Kaveeshwar SA, Cornwall J. The current state of diabetes mellitus in India. The Australasian medical journal. 2014;7(1):45-8.
  5. Balijepalli C, Druyts E, Siliman G, Joffres M, Thorlund K, Mills EJ. Hypoglycemia: a review of definitions used in clinical trials evaluating antihyperglycemic drugs for diabetes. Clinical epidemiology. 2017;9:291-6.
  6. Cryer PE, Davis SN. Hypoglycemia. In: Kasper DL, Fauci AS , Hauser SL , Longo DL , Jameson JL, Loscalzo J editors. Harrison's Principles of Internal Medicine, 19th United States: McGraw-Hill Medical; 2015.p.2430 – 3.
  7. Bode BW, Gross TM, Thornton KR, Mastrototaro JJ. Erratum to “Continuous glucose monitoring used to adjust diabetes therapy improves glycosylated hemoglobin: a pilot study.” Diabetes Research and Clinical Practice. 2000;47(3):225.
  8. Mcgarraugh G, Bergenstal R. Detection of Hypoglycemia with Continuous Interstitial and Traditional Blood Glucose Monitoring Using the FreeStyle Navigator Continuous Glucose Monitoring System. Diabetes Technology & Therapeutics. 2009;11(3):145–50.
  9. Reach G. Continuous glucose monitoring and diabetes health outcomes: a critical appraisal. Diabetes TechnolTher 2008; 10: 69–80.
  10. Shriraam V, Mahadevan S, Anitharani M, Jagadeesh NS, Kurup SB, VidyaTAet al. Reported hypoglycemia in Type 2 diabetes mellitus patients: Prevalence and practices-a hospital-based study. Indian journal of endocrinology and metabolism. 2017 Jan;21(1):148-53.
  11. Dissanayake HA, Keerthisena GS, Gamage KK, Liyanage JH, Ihalagama IR, Wijetunga WM, Tillekaratne TA, Katulanda GW, Katulanda P. Hypoglycaemia in diabetes: do we think enough of the cause? An observational study on prevalence and causes of hypoglycaemia among patients with type 2 diabetes in an out-patient setting in Sri Lanka. BMC endocrine disorders. 2018 Dec;18:35.
  12. Iloh GUP, Collins PI. Hypoglycemia in a resource-poor Nigerian environment: A cross-sectional study of knowledge of symptoms, causes, and self-management practices among ambulatory type 2 diabetic patients in South-East Nigeria. BLDE University Journal of Health Sciences. 2017 Jan 1;2(1):29-37.
  13. Pai SA, George P. Study on awareness of symptoms of hypoglycaemia and early management among patients with diabetes. IOSR J Dent Med Sci. 2015;14:11-13.
  14. Borah M, Goswami RK. Sociodemographic and clinical characteristics of a diabetic population at a tertiary care center in Assam, India. J Soc Health Diabetes 2017;5:37-42.
  15. Seth P, Bery A, Gupta AK. Clinical Profile of Hypoglycemia in Diabetic Patients: A Prospective Study in a Tertiary Care Hospital. Asian Journal of Research in Medical and Pharmaceutical Sciences. 2018; 4(1):1-7.
  16. Krishnan D, Gururajan R, Hafeez-Baig A, Kondalasamy-Chennakesavan S, Wickramasinghe N, Gururajan R. The impact of diet counselling on Type 2 Diabetes Mellitus: an Indian case study. Journal of Diabetes & Metabolism. 2015;6(10).1-10.
  17. Cvetanovic G, Stojiljkovic M, Miljkovic M. Estimation of the influence of hypoglycemia and body mass index on health-related quality of life, in patients with type 2 diabetes mellitus. Vojnosanitetskipregled. 2017; 74(9):831-9.
  18. Ishikawa T, Koshizaka M, Maezawa Y, Takemoto M, Tokuyama Y, Saito T, Yokote K. Continuous glucose monitoring reveals hypoglycemia risk in elderly patients with type 2 diabetes mellitus. Journal of diabetes investigation. 2018 Jan;9(1):69-74.
  19. Bamanikar SA, Bamanikar AA, Arora A. Study of Serum urea and Creatinine in Diabetic and non-diabetic patients in in a tertiary teaching hospital. The Journal of Medical Research. 2016;2(1):12-5.
  20. Gehlaut RR, Dogbey GY, Schwartz FL, Marling CR, Shubrook JH. Hypoglycemia in type 2 diabetes–more common than you think: a continuous glucose monitoring study. J Diabetes Sci Technol 2015; 9: 999–1005.
  21. Huri HZ, Aziz MI, Vethakkan SR, Widodo RT. Factors associated with hypoglycemia episodes in hospitalized type 2 diabetes mellitus patients in a tertiary health facility in Malaysia. Tropical Journal of Pharmaceutical Research. 2016;15(6): 1313-20.
  22. Kalra S, Mukherjee JJ, Venkataraman S, Bantwal G, Shaikh S, Saboo B, Das AK, Ramachandran A. Hypoglycemia: The neglected complication. Indian journal of endocrinology and metabolism. 2013 Sep;17(5):819-34.
  23. Kalra S, Deepak MC, Narang P, Singh V, Maheshwari A. Correlation between measures of hypoglycemia and glycemic improvement in sulfonylurea treated patients with type 2 diabetes in India: Results from the OBSTACLE hypoglycemia study. Journal of Postgraduate Medicine J Postgrad Med. 2014;60(2):151-5
  24. Chan JY, Leyk M, Frier BM, Tan MH. Relationship between HbA1c and hypoglycaemia in patients with type 2 diabetes treated with different insulin regimens in combination with metformin. Diabetes Metab Res Rev 2009;25:224-31.

Corresponding Author

Dr M Sasi Sekhar

MBBS, MD General Medicine, Post Graduate