ANALYSIS OF HYPOGLYCAEMIC EPISODES IN DIABETICS IN AFRICANS
ANALYSIS OF HYPOGLYCAEMIC EPISODES IN DIABETICS IN AFRICANS USING ADEMOLUS CLASSIFICATION OF HYPOGLYCAEMIA BY DR ADEGBENGA BOLANLE ADEMOLU MEDICINE DEPARTMENT LAGOS STATE UNIVERSITY TEACHING HOSPITAL, LAGOS. NIGERIA. Presented poster talk at ENDO 2017 in Orlando Florida. USA. Abstract 595 ademoluab@yahoo. com
INTRODUCTION �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).
INTRODUCTION �Which is the commonest and the least common grade of hypoglycaemia in diabetic African patients? �Which grade of hypoglycaemia is seen commonly in type 1 and in type 2 diabetics in Africa?
METHODOLOGY �This is a retrospective study that analyses 203 (two hundred and three) documented hypoglycaemic episodes, symptomatic or asymptomatic in Africans with diabetes mellitus 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.
METHODOLOGY �To arrive at this 203 documented hypoglycaemic episodes over the study period, the case file (hardware copies) of randomly selected 110 known diabetes mellitus patients admitted over the study period were retrieved and studied. �Of these 50 (fifty) diabetics patients were found to have one or more documented hypoglycaemic episodes as in-patients from which a total of 203 documented hypoglycaemic episodes with absolute values in mg/dl were retrieved.
METHODOLOGY �A questionaire was used as a tool to extract relevant information. �Hypoglycaemia was defined as a blood sugar of 70 mg/dl or less. �Blood sugar check was with the aid of a glucometer.
METHODOLOGY �The inclusion criteria include: �i. known diabetes mellitus patients currently on treatment with either insulin or glucose lowering agents or both, �ii. one or more in-patient admission period for diabetes mellitus or related complication.
METHODOLOGY �Exclusion criteria include: �i. known diabetic patients on out patients with no documented history of hospital admission, �ii. documented hypoglycaemia in non diabetic �iii. in-patients diabetics admissions without a single documented episodes of hypoglycaemia.
RESULTS �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.
FIGURE 1: PERCENTAGE DISTRIBUTION OF HYPOGLYCAEMIC EPISODES IN DIABETICS (BOTH TYPES 1 AND 2) IN AFRICANS. (n=203) 50 45 40 35 30 Column 2 25 Column 1 20 Series 1 15 10 5 0 GRADE 1 GRADE 2 GRADE 3 GRADE 4
RESULTS �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.
FIGURE 2: PERCENTAGE DISTRIBUTION OF HYPOGLYCAEMIC EPISODES IN TYPE 2 DIABETICS IN AFRICANS. 50 45 40 35 30 Column 2 25 Column 1 20 Series 1 15 10 5 0 GRADE 1 GRADE 2 GRADE 3 GRADE 4
RESULTS 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.
FIGURE 3: PERCENTAGE DISTRIBUTION OF HYPOGLYCAEMIC EPISODES IN TYPE 2 DIABETICS ON INSULIN THERAPY ALONE IN AFRICANS. 60 50 40 Column 2 30 Column 1 Series 1 20 10 0 GRADE 1 GRADE 2 GRADE 3 GRADE 4
RESULTS 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.
FIGURE 4: PERCENTAGE DISTRIBUTION OF HYPOGLYCAEMIC EPISODES IN TYPE 2 DIABETICS ON INSULIN THERAPY AND ORAL HYPOGLYCAEMIC AGENTS IN AFRICANS. 50 45 40 35 30 Column 2 25 Column 1 20 Series 1 15 10 5 0 GRADE 1 GRADE 2 GRADE 3 GRADE 4
RESULTS In type 1 diabetics in Africans, 30. 50% had grade 1, 33. 33% had grade 2 while 36. 11% had grade 3 hypoglycaemia.
FIGURE 5: PERCENTAGE DISTRIBUTION OF HYPOGLYCAEMIC EPISODES IN TYPE 1 DIABETICS IN AFRICANS. 37 36 35 34 33 Column 1 32 Column 2 31 Series 1 30 29 28 GRADE 1 GRADE 2 GRADE 3 GRADE 4
RESULTS �The lowest documented hypoglycaemia amongst type 2 diabetics was an asymptomatic fasting blood sugar of 20 mg/dl (grade 3 hypoglycaemia)!
DISCUSSION �It is glaring from this African study that grade 4 hypoglycaemic episodes is not recorded in African diabetics based on this study possibly because most individual with diabetes never suffer very severe hypoglycaemia.
DISCUSSION The commonest grade of hypoglycaemia is grade 1 (mild hypoglycaemia) in type 2 diabetics, this is not surprising since insulin resistance is pathophysiologically an issue whereas grade 3 (severe hypoglycaemia) is the commonest in type 1 diabetics where exogeneous insulin is used due to insulin deficiency. The least common grade of hypoglycaemia in type 2 diabetics is grade 3 while in type 1 diabetics, it is grade 1.
CONCLUSION �Grade 4 hypoglycaemia was not recorded in both type 1 and type 2 diabetes mellitus in this African study. �The commonest grade of hypoglycaemia is grade 1 in type 2 and grade 3 in type 1 diabetics. �The least common grade in type 2 diabetes is grade 3 while in type 1 it is grade 1. �Asymptomatic hypoglycaemia can occur in grade 3 among African diabetics!
CONCLUSION �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.
REFERENCES � 1. Philip E. Cryer, Stephen N. Davis, and Harry Shamoon. Hypoglycemia in Diabetes Care June 2003 vol. 26 no. 6 1902 -1912.
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