Risk of hypoglycemia in patients with diabetes mellitus and comorbidities

Czech version

Authors: Marián Mokáň; Peter Galajda; Dana Prídavková
Authors‘ workplace: I. Interná klinika JLF UK a UN Martin
Published in: Forum Diab 2020; 9(1): 7-12
Category:

Overview

Hypoglycemia is the major limiting factor of the glycemic management in diabetic patients. The main risk factors of hypoglycemia include treatment modality (intensive insulin regiment, derivates of sulphonylurea, strict glycemic control, cardiovascular atherosclerotic disease, disorders of central nervous system (cognitive dysfunction, dementia, depression), diabetic kidney disease, hepatic disorders, cancers a concomitant treatment, including antihypertensive therapy by beta-blockers and inhibitors of system renin-angiotensin. In the case of presence of comorbidities we prefer antidiabetic treatment with low risk of hypoglycemia and with lesser strict glycemic control.

Keywords:

risk factors – cancers – cardiovascular diseases – diabetes mellitus – diabetic kidney disease – disorders of central nervous system – hepatic disorders – hypoglycemia

Sources

Mokáň M, Galajda P. Hypoglykémia u pacientov s diabetes mellitus. QuickPrint: Martin 2019. ISBN 978-80972594-5-7.
Martinka E, Mišániková M. Iatrogénna hypoglykémia ako závažný medicínsky problém. Forum Diab 2016; 5(2): 76–85.
[American Diabetes Association]. 6. Glycemic Targets: Standards of Medical Care in Diabetes 2020. Diabetes Care 2020; 43(Suppl 1): S66-S76. Dostupné z DOI: <http://dx.doi.org/10.2337/dc20-S006>.
Müller N, Lehmann T, Gerste B et al. Increase in the incidence of severe hypoglycaemia in people with type 2 diabetes in spite of new drugs: analysis based on health insurance data from Germany. Diabet Med 2017; 34(9): 1212–1218. Dostupné z DOI: <http://dx.doi.org/10.1111/dme.13397>.
[American Diabetes Association]. 11. Microvascular complications and foot care: Standards of Medical Care in diabetes 2019. Diabetes Care 2019; 42(Suppl 1): S124-S183. Dostupné z DOI: <http://dx.doi.org/10.2337/dc19-S011>.
Epidemiology of severe hypoglycemia in the Diabetes Control and Complications Trial. The DCCT Research Group. Am J Med 1991; 90: 450–459.
Hypoglycemia in the Diabetes Control and Complications Trial. The Diabetes Control and Complications Trial Research Group. Diabetes 1997; 46(2): 271–286.
Boussageon R, Bejan-Angoulvant T, Saadatian-Elahi M et al. Effect of intensive glucose lowering treatment on all causes mortality, cardiovascular death, and microvascular events in type 2 diabetes: meta-analysis of randomised controlled trials. BMJ 2011; 343: d4169. Dostupné z DOI: <http://dx.doi.org/10.1136/bmj.d4169>.
Tkáč I. Effect of intensive glycemic control on cardiovascular outcomes and all-cause mortality in type 2 diabetes: Overview and metaanalysis of five trials. Diab Res Clin Pract 2009; 86(Suppl 1): S57-S62. Dostupné z DOI: <http://dx.doi.org/10.1016/S0168–8227(09)70011–7>.
Pathak RD, Schroeder EB, Seaquist ER et al. Severe hypoglycemia requiring medical intervention in a large cohort of adults with diabetes receiving care in U.S. Integrated Health Care Delivery Systems: 2005–2011. Diabetes Care 2016; 39(3): 363–370. Dostupné z DOI: <http://dx.doi.org/10.2337/dc15–0858>.
Lee AK, Lee CJ, Huang ES et al. Risk factors for severe hypoglycemia in black and white adults with diabetes: The Atherosclerosis Risk in Communities (ARIC) Study. Diabetes Care 2017; 40(12): 1661–1667. Dostupné z DOI: <http://dx.doi.org/10.2337/dc17–0819>.
Lipska KJ, Warton EM, Huang ES et al. HbA1c and risk of severe hypoglycemia in type 2 diabetes: The Diabetes and Aging Study. Diabetes Care 2013; 36(11): 3535–3542. Dostupné z DOI: <http://dx.doi.org/10.2337/dc13–0610>.
ter Braak EW, Appelman AM, van de Laak M et al. Clinical characteristics of type 1 diabetic patients with and without severe hypoglycemia. Diabetes Care 2000; 23(10): 1467–1471. Dostupné z DOI: <http://dx.doi.org/10.2337/diacare.23.10.1467>.
Samoš M, Galajda P, Mokáň M, jr et al. Hypoglykémia u pacientov hospitalizovaných na internom oddelení: prevalencia a najčastejšie príčiny jej vzniku. Forum Diab 2014; 3(1): 34–39.
Yanai H, Adachi H, Katsuyama H et al. Causative anti-diabetic drugs and the underlying clinical factors for hypoglycemia in patients with diabetes. World J Diabetes 2015; 6(1): 30–36. Dostupné z DOI: <http://dx.doi.org/10.4239/wjd.v6.i1.30>.
Leese GP, Wang J, Broomhall J et al. Frequency of severe hypoglycemia requiring emergency treatment in type 1 and type 2 diabetes: a population-based study of health service resource use. Diabetes Care 2003; 26(4): 1176–1180. Dostupné z DOI: <http://dx.doi.org/10.2337/diacare.26.4.1176>.
Hsu PF, Sung SH, Cheng HM et al. Association of clinical symptomatic hypoglycemia with cardiovascular events and total mortality in type 2 diabetes: a nationwide population-based study. Diabetes Care 2013; 36(4): 894–900. Dostupné z DOI: <http://dx.doi.org/10.2337/dc12–0916>.
Martinka E, Uličianský V, Mokáň M et al. Konsenzuálne terapeutické odporúčanie Slovenskej diabetologickej spoločnosti pre diabetes mellitus 2. typu (2018). Vnitř Lék 2018; 64(4): 405–426.
Mokáň M. Hypoglykémia. P+M Turany: Martin 2005. ISBN 8096874268.
Mijnhout GS, Scheltens P, Diamant M et al. Diabetic encephalopathy: a concept in need of a definition. Diabetologia 2006; 49(6): 1447–1448. Dostupné z DOI: <http://dx.doi.orrg/10.1007/s00125–006–0221–8>.
Punthakee Z, Miller ME, Launer LJ et al. Poor cognitive function and risk of severe hypoglycemia in type 2 diabetes: post hoc epidemiologic analysis of the ACCORD trial. Diabetes Care 2012; 35(4): 787–793. Dostupné z DOI: <http://dx.doi.org/10.2337/dc11–1855>.
Signorovitch JE, Macaulay D, Diener M et al. Hypoglycaemia and accident risk in people with type 2 diabetes mellitus treated with non-insulin antidiabetes drugs. Diabetes Obes Metab 2013; 15(4): 335–341. Dostupné z DOI: <http://dx.doi.org/10.1111/dom.12031>.
Yaffe K, Falvey CM, Hamilton N et al. Association between hypoglycemia and dementia in a biracial cohort of older adults with diabetes mellitus. JAMA Intern Med 2013; 173(14): 1300–1306. Dostupné z DOI: <http://dx.doi.org/10.1001/jamainternmed.2013.6176>.
Mattishent K, Loke YK. Bi-directional interaction between hypoglycaemia and cognitive impairment in elderly patients treated with glucose agents: review and meta-analysis. Diabetes Obes Metab 2016; 18(2): 135–141. Dostupné z DOI: <http://dx.doi.org/10.1111/dom.12587>.
Gilsanz P, Karter AJ, Schneider Beeri M et al. The bidirectional association between depression and severe hypoglycemic and hyperglycemic events in type 1 diabetes. Diabetes Care 2018; 41(3): 446–452. Dostupné z DOI: <http://dx.doi.org/10.2337/dc17–1566>.
Lee AK, Lee CJ, Huang ES et al. Risk factors for severe hypoglycemia in black and white adults with diabetes: The Atherosclerosis Risk in Communities (ARIC) Study. Diabetes Care 2017; 40(12): 1661–1667. Dostupné z DOI: <http://dx.doi.org/10.2337/dc17–0819>.
Ahmad I, Zelnick LR, Batacchi Z et al. Hypoglycemia in people with type 2 diabetes and CKD. Clin J Am Soc Nephrol 2019; 14(6): 844–853. Dostupné z DOI: <http://dx.doi.org/10.2215/CJN.11650918>.
Mokáň M, Galajda P. Hypoglykémia pri vybraných vnútorných chorobách. Quickprint: Martin 2011. ISBN 978–80–970660–6–2.
Stumvoll M, Meyer C, Mitrakou A et al. Renal glucose production and utilization: new aspects in humans. Diabetologia 1997; 40(7): 749–775. Dostupné z DOI: <http://dx.doi.org/10.1007/s001250050745>.
Bie-Olsen LG, Pedersen-Bjergaard U, Kjaer TW et al. Association between regional cerebral flow during hypoglycemia and genetic and phenotypic traits of the renin-angiotensin system. J Cereb Blood Flow Metab 2009; 29(11): 1790–1795. Dostupné z DOI: <http://dx.doi.org/10.1038/jcbfm.2009.94>.