Incidence and Risk Factors Associated with Outpatient Hypoglycemia in Patients with Type 2 Diabetes and Chronic Kidney Disease: A Nationwide Study.

Publisher: Informa Healthcare Country of Publication: England NLM ID: 8408548 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1532-4206 (Electronic) Linking ISSN: 07435800 NLM ISO Abbreviation: Endocr Res Subsets: MEDLINE

Publication: London : Informa Healthcare
Original Publication: New York, N.Y. : Dekker, c1984-

Diabetes Mellitus, Type 2/*epidemiology ; Diabetic Nephropathies/*epidemiology ; Hospitalization/*statistics & numerical data ; Hypoglycemia/*epidemiology ; Outpatients/*statistics & numerical data ; Renal Insufficiency, Chronic/*epidemiology; Adult ; Aged ; Aged, 80 and over ; Diabetes Mellitus, Type 2/complications ; Diabetic Nephropathies/etiology ; Diabetic Nephropathies/physiopathology ; Female ; Glomerular Filtration Rate/physiology ; Hospitals, Public/statistics & numerical data ; Humans ; Hypoglycemia/blood ; Hypoglycemia/etiology ; Incidence ; Male ; Middle Aged ; Renal Insufficiency, Chronic/etiology ; Renal Insufficiency, Chronic/physiopathology ; Retrospective Studies ; Risk Factors ; Severity of Illness Index ; Thailand/epidemiology

Background: Chronic kidney disease and hypoglycemia are common complications in individuals with diabetes. Currently, the association of renal function with hypoglycemic complications in type 2 diabetes mellitus (T2DM) is inconclusive. This study aims to assess the associations between estimated glomerular filtration rate (eGFR) and cumulative incidence of hypoglycemia, hypoglycemia-related hospitalizations, and incidence of outpatient hypoglycemia among T2DM patients in Thailand using a nationwide patient sample.
Methods: We conducted a nationwide retrospective cohort study based on the DM/HT study of the Medical Research Network of the Consortium of Thai Medical Schools. This study assessed adult T2DM patients from 831 public hospitals in Thailand in the year 2012-2013. eGFR was categorized into ≥90, 60-89, 30-59, 15-29, and <15 mL/min/1.73 m ² . The associations between eGFR and hypoglycemia, hypoglycemia-related hospitalizations, and incidence of outpatient hypoglycemia were assessed using multivariate logistic regression and Poisson regression.
Results: A total of 25,056 T2DM patients with available eGFR were included in the analysis. The mean age was 60.9 ± 10.5 years. The cumulative incidence of hypoglycemia and hypoglycemia-related hospitalizations was 3.6% and 1.7%, respectively. Incidence of outpatient hypoglycemia, mild hypoglycemia, and severe hypoglycemia was 2.99 (2.59-3.43), 2.47 (2.11-2.88), and 0.52 (0.36-0.72) per 100 patient-years, respectively. Patients with eGFR of 30-59, 15-29, and <15 mL/min/1.73 m ² were significantly associated with an increased risk of hypoglycemia, hypoglycemia-related hospitalizations, and incidence of outpatient hypoglycemia when compared to patients with eGFR of ≥90 mL/min/1.73 m ² .
Conclusion: Reduced eGFR was independently associated with increased hypoglycemia, hypoglycemia-related hospitalizations, and risk of outpatient hypoglycemia. Increasing awareness of the heightened risk of hypoglycemia with declining renal function may prompt changes to diabetic management for at-risk individuals.

Keywords: Hypoglycemia; Type 2 diabetes; chronic kidney disease; hospitalization; renal function

Date Created: 20200715 Date Completed: 20210819 Latest Revision: 20210819

20231215

10.1080/07435800.2020.1792921

32662297