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

Abstract

Objective: The recent grading of severity of hypoglycaemia for use in clinical practice using Ademolus Classification of Hypoglycaemia (ACH) is opening new knowledge path and insight in hypoglycaemia complicating diabetes mellitus management. It is estimated that in 2017 about 726.7 billion U. S. dollars were spent worldwide on health care expenditure due to diabetes mellitus, out of this only 3.3 billion U. S. dollars was spent in Africa. In Africa, hypoglycaemia complicate diabetes mellitus management not only in inpatients but also in out-patients. This article aim to examine hypoglycaemia occurring in African diabetics on out patient pharmacologic management Methods: This is a retrospective study of 200 hypoglycaemic episodes occuring in 88 diabetics attending the out patients of the Endocrinology Clinic of Lagos State University Teaching Hospital, Lagos, Nigeria. between february 2004 and November 2017 (13years and 9 months). Hypoglycaemia was defined as a blood sugar level of 70mg/dl or below. Only documented hypoglycaemic episodes were used. A questionaire was used to extract relevant information from the 88 casefiles. The inclusion criteria includes known diabetics, documented hypoglycaemic episodes occurring during out patient pharmacologic management. The analysis was done with the aid of SPSS Version 17.0 Results: Of the 200 hypoglycaemic episodes studied,79.5 were grade 1, grade 2 were 18% while 2.5% were grade 3.(see figure 1) In all type 2 diabetics (T2DM),82.9% had grade 1 hypoglycaemia,14.6% had grade 2, while 2.4% had grade 3. In all Type 1 diabetics (T1DM) 66.7% had grade 1 hypoglycaemia,30.6% had grade 2 while 2.7% had grade 3. The lowest hypoglycaemic episode among out patient T2DM was an asymptomatic value of 29mg/dl (grade 3 hypoglycaemia!). Discussion: The majority of out patient hypoglycaemic episodes in African diabetics is grade 1 while only a minute proportion develop grade 3 as out patient. The majority of T2DM had mild hypoglycaemic episodes irrespective of whether they are on oral hypoglycaemic agents (OHA) alone , or on OHA and insulin or on insulin only. Though the percentage of grade 1 hypoglycaemia in each category differ. Among African T1DM, grade 1 hypoglycaemia is twice as common as grade 2 hypoglycaemia while severe hypoglycaemia is not common. Grade 4 hypoglycaemic episodes was not recorded over the 13 years and 9 months period of study in both T1DM and T2DM in Africans. Conclusion: Mild (grade 1), moderate (grade 2) and severe (grade 3) hypoglycaemia can all occur in Afrcan diabetics on out patients basis but with the majority of the episodes occurring as grade 1. Asymptomatic grade 3 hypoglycaemia can occur in African T2DM as out patient. A similar study is advised in other regions of the world.