Hypoglycemia is an important and harmful complication of Diabetes Mellitus (DM) that often occurs in inpatient or outpatient settings. Hypoglycemia can be divided into two types, i.e. primary hypoglycemia when hypoglycemia is the main diagnosis for admission, whereas secondary hypoglycemia if hypoglycemia occurs during hospitalization. Hypoglycemia during hospitalization or secondary hypoglycemia may arise from various risk factors, such as advanced age, comorbid diseases, type of diabetes, previous history of hypoglycemia, body mass index, hyperglycemia therapy given, as well as other risk factors such as inadequate glucose monitoring, unclear or unreadable physician instructions, limited health personnel, limited facilities, prolonged fasting and incompatibility of nutritional intake and therapy administered. Hypoglycemia can lead to medical and non-medical impacts, such as increased mortality, cardiovascular disorders, cerebrovascular disorders, and increased health care costs and length of stay. The incidence of inpatient hypoglycemia can actually be prevented by controlling modifiable risk factors and also giving education about hypoglycemia to patients and health workers. We performed a literature research in Pubmed, EBSCOhost, and Scopus to review the possible risk factors for inpatient hypoglycemia. Eleven studies were retrieved. We presented the result of these studies as well as a brief overview of the epidemiology, pathophysiology, impact and preventive strategy.

Background: Diabetic foot is one of major complication in diabetes patients with unfavorable outcome. Survival study in outpatients is limited and factors related are inconsistent. Survival and its modifiable risk factors should be identified early since the foot at risk status to reduce amputation/mortality in type 2 diabetes mellitus (T2DM). Objective: The aims of this study were to investigate survival probability for amputation or mortality, compare different ulcer risk classification, and figure out the relation of status of ulcer risk, age, gender, diabetes duration, body mass index, fasting plasma glucose, HbA1C, and LDL with amputation or mortality. Methods: This is a retrospective cohort study of 487 T2DM subjects who visited internal medicine outpatient clinic in Fatmawati General Hospital since January-December 2016. Status of ulcer risk and risk factors were extracted from medical record and lower-extremity amputation or mortality was observed in 3 years from baseline. Result: Three years overall survival is 85.7% (SE 0.17). Patients with high risk for foot ulcer have survival probability of 80.2% (SE 0.027), which is lower compared to non-high risk for foot ulcer with survival probability of 91.8% (SE 0.019). Patients with high risk for foot ulcer (aHR 2.386 [95% CI 1.356-4.20]; P = .003), aged ≥60 years old (aHR 2.051 [95% CI 1.173-3.585]; P = .012), and HbA1C ≥7% (aHR 2.022 [95% CI 1.067-3.830]; P = .031) were independently associated with amputation or mortality. Conclusion: T2DM patients with high risk for foot ulcer have lower survival probability and higher risk for amputation or mortality in 3 years compared to patients with non-high risk for foot ulcer. Status of ulcer risk, age ≥60 years, and HbA1C ≥7% were associated with amputation or mortality in 3 years observation.

BackgroundAs the country with the 7th largest number of People with Diabetes (PWD) in the world, the COVID-19 pandemic, and the Large Social Scale Restriction (LSSR) policy taken by the Indonesian government to reduce the number of COVID-19 transmissions is estimated to interfere diabetes management and will increase the incidence of diabetes complications. This study aims to determine the difficulties of diabetes management and its impact on diabetes morbidity during the COVID-19 pandemic in Indonesia.MethodologyThis study is a cross-sectional study using a national scale web survey. This research was conducted in Indonesia enrolling 1,124 PWD aged 18 years or older. Diabetes complications are defined as any incidence of hypoglycaemia, or Diabetic Foot Ulcer (DFU), or hospital admission experienced by PWD in Indonesia during the COVID-19 pandemic. The correlation between diabetes management difficulties and diabetes-related complications was measured using a modified cox regression test.ResultsDiabetes management difficulties were experienced by 69.8% of PWD in Indonesia. The difficulties include attending diabetes consultation 30.1%, access to diabetes medication 12.4%, checking blood sugar levels 9.5%, controlling diet 23.8%, and performing regular exercise 36.5%. Diabetes-related complications occurred in 24.6% of subjects. Those who had diabetes management difficulties during the COVID-19 pandemic are prone to have diabetes complications by 1.4 times greater (PR: 1.41, 95% CI: 1.09-1.83) than those who did not.ConclusionThe COVID-19 pandemic and LSSR have a substantial impact on diabetes management and indirectly increased diabetes morbidity in Indonesia.

Introduction. Hypoglycemia is an important and harmful complication that often occurs in inpatient and outpatient settings. This study aims to assess the incidence of inpatient hypoglycemia and its related factors. We also assessed mortality and length of hospital stay.Methodology. We performed a retrospective cohort study among patients with type 2 diabetes mellitus admitted to a tertiary hospital in Indonesia. Using multivariate regression, we analyzed age, sex, body mass index, comorbidities, history of hypoglycemia, hyperglycemia treatment administered, nutritional intake, and medical instruction as the related risk factors for inpatient hypoglycemia.Results. From 475 subjects, 80 (16.8%) had inpatient hypoglycemia, of which, 7.4% experienced severe hypoglycemia. We found that patients with a history of hypoglycemia (RR: 4.6; 95% CI: 2.8-7.6), insulin and/or sulfonylurea treatment (RR 6.4; 95% CI: 1.6-26.5), and inadequate nutritional intake (RR 2.6; 95% CI: 1.5-4.3) were more likely to have hypoglycemic events compared to those who did not. The length of hospital stay for patients in the hypoglycemic group is significantly longer than those in the non-hypoglycemic group (13 vs 7 days, p<0.001), but their mortality rates did not differ (16% vs 10.9%, p=0.18). Conclusion.Inpatient hypoglycemia may be affected by a history of hypoglycemia and inadequate nutritional intake. Patients who had inpatient hypoglycemia tend to have a longer median length of hospital stay.

Indonesia is struggling with a rapidly growing burden of diabetes due to rapid socioeconomic transition. People with type 2 diabetes mellitus (T2DM) need appropriate treatment strategies to maintain glycemic control. New modalities with simplicity, such as fixed-ratio combination of basal insulin and glucagon-like peptide-1 receptor agonist (GLP-1 RA), further referred to as FRC, have proven to be an effective and practical therapeutic approach that may address this issue. In January 2021, a scientific expert meeting was held with the participation of endocrinologists from Indonesia to provide expert opinions regarding the optimal practical use of the FRC basal insulin/GLP1-RA. Topics discussed in the meeting included the challenges in diabetes management, clinical inertia with insulin therapy, local and international guideline positioning, initiation, titration, and switching of basal insulin and GLP-1 RA, including FRC, and the management of T2DM.