Prevalence of Hypoglycemia Among Type 2 Diabetics Undergoing Hemodialysis in a University Hospital

Maria Concepcion H. Gungon, Elaine C. Cunanan

May 2020 DOI 10.35460/2546-1621.2018-0057     Access   

Abstract

Background: The overall increase in the number of people with diabetes mellitus has a major impact on the increasing number of patients with diabetic kidney disease (DKD). Hypoglycemia that is brought about by altered glucose homeostasis and the hemodialysis process in patients with DKD poses a great challenge to clinicians in achieving blood glucose control. This study has been undertaken to evaluate the prevalence of hypoglycemia among diabetics undergoing hemodialysis and determine the clinical factors predicting the development of hypoglycemia.

Methods: We conducted a prospective, cross-sectional study that included 75 patients with diabetes mellitus undergoing maintenance hemodialysis at the University of Santo Tomas Hospital, Center for Kidney Disease. The patients’ predialysis and hourly intradialytic serum glucose levels were measured until the end of the session. Hypoglycemia was considered as a blood glucose ≤70 mg/dL with/without symptoms.

Results: Elderly patients and in-hospital patients tend to develop hypoglycemia with a p-value of 0.0028 and 0.001, respectively. Old age (p-value 0.0093), female sex (p-value 0.0224), hypertension (p-value 0.0301), CAD (p-value 0.0058), frequency of hemodialysis (p-value 0.0000), no caloric intake during the dialysis session (p-value 0.0022) and admission (p-value 0.0007) predicted hypoglycemia in our study.

Conclusions: In conclusion, the prevalence of hypoglycemia among patients with type 2 diabetes mellitus undergoing maintenance hemodialysis in our setting is 12%. There is an increased rate of hypoglycemia amongst the elderly as well as admitted patients. Our results identified old age, presence of CAD, increased frequency of hemodialysis and hospital admission as the predictors of hypoglycemia.

  1. World Health Organization Western Pacific Region. Philippines: health situation and trend: communicable and non-communicable diseases, health risk factors and transition. Manila, Philippines. World Health Organization Regional Office for the Western Pacific. Available at: http://www.wpro.who.int/publications/CHIPS2010.pdf; 2010.
  2. Tuttle KR, Bakris GL, Bilous RW, Chiang JL, de Boer IH, Goldstein-Fuchs J, et al. Diabetic kidney disease: A report from an ADA consensus conference, diabetes care. 2014 Oct;37(10):2864–83. Available at: https://doi.org/10.2337/dc14-1296.
  3. Moen MF, Zhan M, Hsu VD, Walker LD, Einhorn LM, Seliger SL, et al. Frequency of hypoglycemia and its significance in chronic kidney disease. Clin J Am Soc Nephrol. 2009;4:1121–7.
  4. National Kidney Foundation. KDOQI clinical practice guideline for diabetes and CKD: 2012 update. Am J Kidney Dis. 2012;60:850–86.
  5. Rhee CM, Leung AM, Kovesdy CP, Lynch KE, Brent GA, Kalantar-Zadeh K, et al. Updates on the management of diabetes in dialysis patients. Semin Dial. 2014;27:135–45. doi: 10.1111/sdi.12198
  6. Woerle HJ, Meyer C, Popa EM, Cryer PE, Gerich JE. Renal compensation for impaired hepatic glucose release during hypoglycemia in type 2 diabetes: Further evidence for hepatorenal reciprocity. Diabetes. 2003;52:1386–92.
  7. International Hypoglycaemia Study Group. Glucose concentrations of less than 3.0 mmol/L (54 mg/dL) should be reported in clinical trials: a joint position statement of the American Diabetes Association and the European Association for the Study of Diabetes. Diabetes Care. 2017;40:155–7.
  8. Chiao-Yin S, Chin-Chan L, Wu MS. Hypoglycemia in diabetic patients undergoing chronic hemodialysis. Therapeutic apheresis and dialysis. 2009 Apr; 13(2):95–102.
  9. Abe M, Kalantar-Zadeh K. Haemodialysis-induced hypoglycaemia and glycaemic disarrays. Nature Reviews Nephrology. 2015;11:302–13.
  10. Kalantar-Zadeh, Derose SF, Nicholas S, Benner D, Kumar Sharma, Kovesdy CP. Burnt-out diabetes: The impact of CKD progression on the natural course of diabetes mellitus. J Ren Nutr. 2009 Jan;19(1):33–37.
  11. Nakamura Y, Hasegawa H, Tsuji M, Udaka Y, Mihara M, Shimizu T, et al. Diabetes therapies in hemodialysis patients: Dipeptidase-4 inhibitors. World J Diabetes. 2015 Jun 25;6(6):840.
  12. Kagansky N, Levy S, Rimon E, Cojocaru L, Fridman A, Ozer Z, Knobler H. Hypoglycemia as a predictor of mortality in hospitalized elderly patients. Arch Intern Med. 2003 Aug 11-25;163(15):1825–9.
  13. NICE-SUGAR Study Investigators. Finfer S, Liu B, Chittock DR, Norton R, Myburgh JA, et al. Hypoglycemia and risk of death in critically ill patients. N Engl J Med. 2012;367(12):1108–118.
  14. Hulkower RD, Pollack RM, Zonsnein J. Understanding hypoglycaemia in hospitalized patients. Diabetes Management (Lon). 2014 Mar;4(2):165–76.
  15. Davis SN, Fowler S, Costa F. Hypoglycemic counterregulatory responses differ between men and women with type 1 diabetes. Diabetes. 2000;4965–72.
  16. Kalantar-Zadeh K, Ikizler T. Let them eat during dialysis: An overlooked oppurtunity to improve outcome in maintenance hemodialysis patients. J Ren Nutr. 2013 May;23(3):157–163.
  17. Burmeister JE, Scapini A, da Rosa Miltersteiner D, da Costa MG, Campos BM. Glucose-added dialysis fluid prevents asymptomatic hypoglycaemia in regular haemodialysis. Nephrol Dial Transplant. 2007;22:1184–9.
  18. Gerich JE, Mokan M, Veneman T, Korytkowski M, Mitrakou A. Hypoglycemia unawareness. Endocr Rev. 1991 Nov;12(4):356–71.

Articles related to the one you are viewing

There are currently no results to show, please try again later

CC BY: Open Access Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons license, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons license and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/