Analysis of Hypoglycaemic Episodes in Diabetics in Africans Using Ademolus Classification of Hypoglycaemia

Presentation Number: MON 595
Date of Presentation: April 3rd, 2017

Adegbenga BOLANLE Ademolu*
Lagos State University Teaching Hospital (LASUTH), Ikeja, Nigeria

Abstract

Hypoglycaemia as a management complication of diabetes mellitus (DM) is a world wide experience. ln Africa,hypoglycaemia is an uncharted territory in literature.To add to the existing knowledge therefore,the following questions will be addressed using Ademolus Classification of Hypoglycaemia (ACH).Which is the commonest and the least common grade of hypoglycaemia in DM African patients? Which grade of hypoglycaemia is seen commonly in type 1 and in type 2 diabetics?This is a retrospective study that analyses 203 (two hundred and three) documented hypoglycaemic episodes,symptomatic or asymptomatic in Africans with DM admitted between July 2007 and October 2016 (9 years and three months period) in the medicine departments of Lagos State University Teaching Hospital,Ikeja,Lagos Nigeria.A questionaire was used as a tool to extract relevant information from each of the relevant 50 case files studied.Hypoglycaemia was defined as a blood sugar of 70mg/dl or less.Blood sugar check was with the aid of a glucometer.The age range of the patients was 18 to 95 years.Now by using ACH to analyse the 203 hypoglycaemic episodes,45.32% had grade 1 hypoglycaemia,35.47% had grade 2 hypoglycaemia while 19.21% had grade 3 hypoglycaemia.ln all type 2 diabetics studied,48.50% had grade l hypoglycaemia,35.93% had grade 2 hypoglycaemia while 15.57% had grade 3 hypoglycaemia.ln type 2 DM patients on insulin therapy alone, 53.54% had grade 1 hypoglycaemia,31.50% had grade 2 hypoglycaemia while 14.96% had grade 3 hypoglycaemia.In type 2 diabetics on both insulin and oral hypoglycaemic agents ,33.33% had grade 1 hypoglycaemia,48.72% had grade 2 hypoglycaemia while 17.95% had grade 3 hypoglycaemia.In type 1 DM,30.50% had grade 1,33.33% had grade 2 while 36.11% had grade 3 hypoglycaemia.The lowest documented hypoglycaemia amongst type 2 DM was an asymptomatic fasting blood sugar of 20mg/dl (grade 3 hypoglycaemia)!By using ACH,there was no record of grade 4 hypoglycaemia in both type 1 and type 2 DM patients in this African study possibly because most individual with diabetes never suffer very severe hypoglycaemia.The commonest grade of hypoglycaemia is grade 1 (mild hypoglycaemia) in type 2 DM,this is not surprising since insulin resistance is pathophysiologically an issue whereas grade 3 (severe hypoglycaemia) is the commonest in type 1 DM where exogeneous insulin is used due to insulin deficiency.The least common grade of hypoglycaemia in type 2 DM is grade 3 while in type 1 DM, it is grade 1.Asymtomatic hypoglycaemia can occur in grade 3 among African diabetics!A similar study is recommended in Americans,Europeans,Asians and all ethnic groups for possible racial differences or disparity in the findings of this research.

Reference:

  1. Philip E. Cryer,Stephen N. Davis, and Harry Shamoon. Hypoglycemia in Diabetes . Diabetes Care June 2003 vol. 26 no. 6 1902-1912 .

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Nothing to Disclose: ABA