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Analysis of Hypoglycemic Episodes in Out Patient Diabetic in Africans Using Ademolus Classification of Hypoglycemia

Received: 23 February 2020     Accepted: 24 March 2020     Published: 14 April 2020
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Abstract

The recent grading of severity of hypoglycemia for use in clinical practice using Ademolus Classification of Hypoglycemia (ACH) is opening a new knowledge path and insight in hypoglycemia complicating diabetes mellitus management. In Africa like other parts of the world, hypoglycemia complicates diabetes mellitus management in in and out-patients. This article aims to examine hypoglycemia occurring in African diabetics on out patient pharmacologic management. This is a retrospective study of 200 hypoglycemic episodes occurring in 88 diabetics attending the out patients of the Endocrinology Clinic of Lagos State University Teaching Hospital, Lagos, Nigeria. Over 13years and 9 months period. Data were analysed using ADEMOLUS CLASSIFICATION OF HYPOGLYCEMIA and American Diabetes Association (ADA)/European Association for the Study of Diabetes (EASD) 2018 Classification of Hypoglycemia. Only documented hypoglycemic episodes were studied using a questionnaire. The inclusion criteria includes known diabetics, documented hypoglycemic episodes occurring during out patient pharmacologic management. This study was analysed using SPSS version 17. Of the 200 hypoglycemic episodes studied, 79.5% were grade 1, grade 2 were 18% while 2.5% were grade 3. In all type 2 diabetics (T2DM), 82.9% had grade 1 hypoglycemia, 14.6% had grade 2, while 2.4% had grade 3. The lowest hypoglycemic episode among out patient T2DM was an asymptomatic value of 29mg/dl (grade 3 hypoglycemia!). There is an inverse relationship between hypoglycemic episodes recorded in type 1 and type 2 diabetics as the pearson correlation was -1.000. This denotes a perfect negative correlation between hypoglycemic episodes developed in type 1 compared to type 2 diabetics in Africans. There is no linear relationship between these two variables. With a p-value of 0.000, the null hypothesis is discarded in this study as these findings is not due to chance or error of sampling but rather are statistically significant. ADA/EASD 2018 classification of hypoglycemia is not very sensitive in diagnosing severe hypoglycemia in that it recognized only 1 hypoglycemic episodes while ACH recognizes five. The five cases all have blood sugar of less than 40mg/dl yet ADA/EASD 2018 classification recognizes only one because it developed a severe event from hypoglycemia needing assistance from a third party. The majority of T2DM had mild hypoglycemic episodes irrespective of whether they are on oral hypoglycemic agents (OHA) alone, or on OHA and insulin or on insulin alone. Among African T1DM, grade 1 hypoglycemia is twice as common as grade 2 hypoglycemia while severe hypoglycemia is not common. Grades 1, 2 and 3 hypoglycemia can all occur in African diabetics on out patients basis but with the majority occurring as grade 1. Asymptomatic grade 3 hypoglycemia can occur in out patient African T2DM. A similar study is advised in other regions of the world.

Published in International Journal of Diabetes and Endocrinology (Volume 5, Issue 1)

This article belongs to the Special Issue Hypoglycemia in Diabetes

DOI 10.11648/j.ijde.20200501.13
Page(s) 9-17
Creative Commons

This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.

Copyright

Copyright © The Author(s), 2020. Published by Science Publishing Group

Keywords

Hypoglycemia, Diabetes Mellitus, Africans, Ademolus Classification of Hypoglycemia, Out Patients

References
[1] Health care expenditure due to diabetes worldwide in 2017, by region (in billion U.S. dollars).
[2] Chipo Mutyambizi, Milena Pavlova, Lumbwe Chola, Charles Hongoro, and Wim Groo. Cost of diabetes mellitus in Africa: a systematic review of existing literature. Global Health. 2018; 14: 3.
[3] Ademolu AB, Ademolu AO, Ogbera AO, Fasanmade OA. (2015) Hypoglycemia in lkorodu. Journal of Asian Health.
[4] Ademolu AB (2017) Role of Ademolus Classification of Hypoglycemia in Blood Glucose and Diabetes Mellitus Management. Gastroenterol Liver Clin Med (2017) 1: 1 003.
[5] Adegbenga B Ademolu (2019) Analysis of Hypoglycemic Episodes in Diabetics in Africans Using Ademolus Classification of Hypoglycemia (ACH). Acta Scientific Medical Sciences 3 (3): 138-145.
[6] Halefom Kahsay, Bereket Fantahun, Teshome Nedi, and Gebre Teklemariam Demoz. Evaluation of Hypoglycemia and Associated Factors among Patients with Type 1 Diabetes on Follow-Up Care at St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia Journal of Diabetes Research. Volume 2019. Article ID 9037374.
[7] Andrew J Karter, Kasia J Lipska, and John F. Steiner. High Rates of Severe Hypoglycemia among African American Patients with Diabetes: The Surveillance, Prevention, and Management of Diabetes Mellitus (SUPREME-DM) Network. J Diabetes Complications. 2017 May; 31 (5): 869–873.
[8] American Diabetes Association. Hospital Admission Guidelines for Diabetes. Diabetes Care 2004 Jan; 27 (suppl 1): s103-s103.
[9] Myriam Zaydee Allende-Vigo, Rafael A. González-Rosario, and Raul O. Ramón, Inpatient Management of Diabetes Mellitus Among Noncritically Ill Patients At The University Hospital Of Puerto Rico. Endocr Pract. 2014 May; 20 (5): 452–460.
[10] Ojobi JE, Dunga J, Ogiator MO, Mbaave P, Bello RN. INDICATIONS AND OUTCOME OFADMISSION OF DIABETIC PATIENTS INTO THE MEDICALWARDS IN A NIGERIAN TERTIARY HOSPITAL- ATWO YEAR REVIEW. Jos Journal of Medicine, Volume 11 No. 2.
[11] American Diabetes Association. “Standards of Medical Care in Diabetes-2019”. Diabetes Care 42 (2019): S1-S2.
[12] Alessandro Mantovani, Giorgio Grani, [...], and Enzo Bonora. Severe hypoglycemia in patients with known diabetes requiring emergency department care: A report from an Italian multicenter study. J Clin Transl Endocrinol. 2016 Sep; 5: 46–52.
[13] Yon Su Kim, Be Long Cho, and Chang Gyu Park. Frequency and Severity of Hypoglycemia in Type 2 Diabetes Mellitus Patients Treated with a Sulfonylurea-Based Regimen at University-Affiliated Hospitals in Korea: The Naturalistic Evaluation of Hypoglycemic Events in Diabetic Subjects Study. Korean J Fam Med. 2019 Jul; 40 (4): 212–219.
[14] Philip E. Cryer, Stephen N. Davis, and Harry Shamoon, M. Hypoglycemia in Diabetes. Diabetes Care 2003 Jun; 26 (6): 1902-1912.
[15] Adriana M. Hung,; Edward D. Siew; Otis D. Wilson; Amy M. Perkins; Robert A. Greevy; Jeffrey Horner et al. Risk of Hypoglycemia Following Hospital Discharge in Patients With Diabetes and Acute Kidney Injury Diabetes Care 2018 Mar; 41 (3): 503-512.
[16] Gautret P, Lagier JC, Parola P, Hoang VT, Meddeb L, Mailhe M et al. Hydroxychloroquine and azithromycin as a treatment of COVID-19: results of an open-label non-randomized clinical trial. Int J Antimicrob Agents. 2020 Mar 20: 105949.
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  • APA Style

    Adegbenga Bolanle Ademolu. (2020). Analysis of Hypoglycemic Episodes in Out Patient Diabetic in Africans Using Ademolus Classification of Hypoglycemia. International Journal of Diabetes and Endocrinology, 5(1), 9-17. https://doi.org/10.11648/j.ijde.20200501.13

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    ACS Style

    Adegbenga Bolanle Ademolu. Analysis of Hypoglycemic Episodes in Out Patient Diabetic in Africans Using Ademolus Classification of Hypoglycemia. Int. J. Diabetes Endocrinol. 2020, 5(1), 9-17. doi: 10.11648/j.ijde.20200501.13

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    AMA Style

    Adegbenga Bolanle Ademolu. Analysis of Hypoglycemic Episodes in Out Patient Diabetic in Africans Using Ademolus Classification of Hypoglycemia. Int J Diabetes Endocrinol. 2020;5(1):9-17. doi: 10.11648/j.ijde.20200501.13

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  • @article{10.11648/j.ijde.20200501.13,
      author = {Adegbenga Bolanle Ademolu},
      title = {Analysis of Hypoglycemic Episodes in Out Patient Diabetic in Africans Using Ademolus Classification of Hypoglycemia},
      journal = {International Journal of Diabetes and Endocrinology},
      volume = {5},
      number = {1},
      pages = {9-17},
      doi = {10.11648/j.ijde.20200501.13},
      url = {https://doi.org/10.11648/j.ijde.20200501.13},
      eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ijde.20200501.13},
      abstract = {The recent grading of severity of hypoglycemia for use in clinical practice using Ademolus Classification of Hypoglycemia (ACH) is opening a new knowledge path and insight in hypoglycemia complicating diabetes mellitus management. In Africa like other parts of the world, hypoglycemia complicates diabetes mellitus management in in and out-patients. This article aims to examine hypoglycemia occurring in African diabetics on out patient pharmacologic management. This is a retrospective study of 200 hypoglycemic episodes occurring in 88 diabetics attending the out patients of the Endocrinology Clinic of Lagos State University Teaching Hospital, Lagos, Nigeria. Over 13years and 9 months period. Data were analysed using ADEMOLUS CLASSIFICATION OF HYPOGLYCEMIA and American Diabetes Association (ADA)/European Association for the Study of Diabetes (EASD) 2018 Classification of Hypoglycemia. Only documented hypoglycemic episodes were studied using a questionnaire. The inclusion criteria includes known diabetics, documented hypoglycemic episodes occurring during out patient pharmacologic management. This study was analysed using SPSS version 17. Of the 200 hypoglycemic episodes studied, 79.5% were grade 1, grade 2 were 18% while 2.5% were grade 3. In all type 2 diabetics (T2DM), 82.9% had grade 1 hypoglycemia, 14.6% had grade 2, while 2.4% had grade 3. The lowest hypoglycemic episode among out patient T2DM was an asymptomatic value of 29mg/dl (grade 3 hypoglycemia!). There is an inverse relationship between hypoglycemic episodes recorded in type 1 and type 2 diabetics as the pearson correlation was -1.000. This denotes a perfect negative correlation between hypoglycemic episodes developed in type 1 compared to type 2 diabetics in Africans. There is no linear relationship between these two variables. With a p-value of 0.000, the null hypothesis is discarded in this study as these findings is not due to chance or error of sampling but rather are statistically significant. ADA/EASD 2018 classification of hypoglycemia is not very sensitive in diagnosing severe hypoglycemia in that it recognized only 1 hypoglycemic episodes while ACH recognizes five. The five cases all have blood sugar of less than 40mg/dl yet ADA/EASD 2018 classification recognizes only one because it developed a severe event from hypoglycemia needing assistance from a third party. The majority of T2DM had mild hypoglycemic episodes irrespective of whether they are on oral hypoglycemic agents (OHA) alone, or on OHA and insulin or on insulin alone. Among African T1DM, grade 1 hypoglycemia is twice as common as grade 2 hypoglycemia while severe hypoglycemia is not common. Grades 1, 2 and 3 hypoglycemia can all occur in African diabetics on out patients basis but with the majority occurring as grade 1. Asymptomatic grade 3 hypoglycemia can occur in out patient African T2DM. A similar study is advised in other regions of the world.},
     year = {2020}
    }
    

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    AB  - The recent grading of severity of hypoglycemia for use in clinical practice using Ademolus Classification of Hypoglycemia (ACH) is opening a new knowledge path and insight in hypoglycemia complicating diabetes mellitus management. In Africa like other parts of the world, hypoglycemia complicates diabetes mellitus management in in and out-patients. This article aims to examine hypoglycemia occurring in African diabetics on out patient pharmacologic management. This is a retrospective study of 200 hypoglycemic episodes occurring in 88 diabetics attending the out patients of the Endocrinology Clinic of Lagos State University Teaching Hospital, Lagos, Nigeria. Over 13years and 9 months period. Data were analysed using ADEMOLUS CLASSIFICATION OF HYPOGLYCEMIA and American Diabetes Association (ADA)/European Association for the Study of Diabetes (EASD) 2018 Classification of Hypoglycemia. Only documented hypoglycemic episodes were studied using a questionnaire. The inclusion criteria includes known diabetics, documented hypoglycemic episodes occurring during out patient pharmacologic management. This study was analysed using SPSS version 17. Of the 200 hypoglycemic episodes studied, 79.5% were grade 1, grade 2 were 18% while 2.5% were grade 3. In all type 2 diabetics (T2DM), 82.9% had grade 1 hypoglycemia, 14.6% had grade 2, while 2.4% had grade 3. The lowest hypoglycemic episode among out patient T2DM was an asymptomatic value of 29mg/dl (grade 3 hypoglycemia!). There is an inverse relationship between hypoglycemic episodes recorded in type 1 and type 2 diabetics as the pearson correlation was -1.000. This denotes a perfect negative correlation between hypoglycemic episodes developed in type 1 compared to type 2 diabetics in Africans. There is no linear relationship between these two variables. With a p-value of 0.000, the null hypothesis is discarded in this study as these findings is not due to chance or error of sampling but rather are statistically significant. ADA/EASD 2018 classification of hypoglycemia is not very sensitive in diagnosing severe hypoglycemia in that it recognized only 1 hypoglycemic episodes while ACH recognizes five. The five cases all have blood sugar of less than 40mg/dl yet ADA/EASD 2018 classification recognizes only one because it developed a severe event from hypoglycemia needing assistance from a third party. The majority of T2DM had mild hypoglycemic episodes irrespective of whether they are on oral hypoglycemic agents (OHA) alone, or on OHA and insulin or on insulin alone. Among African T1DM, grade 1 hypoglycemia is twice as common as grade 2 hypoglycemia while severe hypoglycemia is not common. Grades 1, 2 and 3 hypoglycemia can all occur in African diabetics on out patients basis but with the majority occurring as grade 1. Asymptomatic grade 3 hypoglycemia can occur in out patient African T2DM. A similar study is advised in other regions of the world.
    VL  - 5
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Author Information
  • Medicine Department, Lagos State University Teaching Hospital, Ikeja, Lagos, Nigeria

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