Self-reported hypoglycemia in adult diabetic patients in East Gojjam, Northwest Ethiopia: institution based cross-sectional study

Abstract

BackgroundHypoglycemia presents a barrier to optimum diabetes management and it is related to a negative impact on health-related quality of life, healthcare resource use, and work productivity. Despite the fact that the magnitude of hypoglycemia and factors associated with hypoglycemia in diabetic population were demonstrated in clinical trial settings; there is no adequate evidence concerning to the problem in real-world settings, in particular in the study area. The aim of the study was to assess the magnitude of hypoglycemia and factors associated with hypoglycemia among adult diabetic patients attending chronic follow up clinic at Debre Markos referral hospital, East Gojjam Zone, Northwest Ethiopia, 2017.MethodsAn institution-based cross-sectional study was conducted among 394 sampled diabetic patients who were selected through systematic random sampling technique at Debre Markos referral hospital. Data were collected using structured interviewer-administered questionnaire. The collected data were entered and cleared using epi-data version 3.1 and analyzed by SPSS version 20. We used bivariate and multivariate logistic regression models to identify variables for multivariate analysis and to identify associated factors for hypoglycemia, respectively.ResultThe study revealed that 279(70.8%) of diabetic patients had experienced hypoglycemic event since the diagnosis of diabetes. Patients with type 1 diabetes were more likely to have hypoglycemia as compared with type 2 diabetic patients. The factors found to be significantly associated with hypoglycemia included type 2 diabetes (AOR 0.34, 95%CI: 0.14, 0.82), duration of diabetes from 10 to 14 years (AOR 6.34, 95%CI: 2.12, 18.96) and insulin therapy (AOR 4.93, 95%CI: 2.05, 11.86). Diabetic patients who are government employees (AOR = 0.29, 95%CI: 0.11, 0.78) were less likely to have hypoglycemia when compared to farmers.ConclusionThe magnitude of hypoglycemia was found to be high and significantly associated with occupation, type of diabetes mellitus, type of medication and duration of diabetes mellitus since diagnosis. Therefore, attention is needed from health-related governmental organizations and health care providers to decrease the burden of hypoglycemia and to address the major contributing factors.

Hypoglycemia Among Type 1 Diabetes Patients After Insulin Use in Southwest Ethiopia

“…Besides this, it could be due to the fact that those who are treated for a long duration may have become fatigued and caught napping on the techniques to administer insulin by themselves. This finding was supported by studies done in Ethiopia (5,22).…”

“…Diabetes mellitus significantly contributes to the global health burden in the 21 st century (1). Achieving good glycemic control is a valuable goal for people with diabetes (2); however, hypoglycemia is the greatest challenge to achieving tight glycemic control (3)(4)(5)(6)(7), which results in declined drug compliance, cardiovascular events, and even mortality (3). It is also related to a negative impact on health-related quality of life, healthcare resource use, and work productivity (5).…”

“…Hypoglycemic events are probably common in diabetic patients who use insulin (4,(8)(9)(10)(11)(12), and patients with type 1 diabetes (T1D) are more likely to develop hypoglycemia as compared with type 2 diabetic patients (4,5,13,14). One of the most feared complications of diabetes treatment is hypoglycemia (15), which commonly occurs in clinical practice as approximately 90% of all patients who receive insulin have experienced hypoglycemic episodes (16).…”

“…The factors associated with hypoglycemia are varied. It may include age, sex, occupational status, residence, body mass index, missed meals or inadequate caloric intake, alcohol consumption, concurrent use of an opioid, level of fasting blood sugar, blood glucose monitoring, glucose checkup period, insulin or diabetes medications, duration of diabetes, and presence of stroke (3,5,8,(21)(22)(23)(24).…”

Ongoing and planned activities to improve the management of patients with Type 1 diabetes across Africa; implications for the future

“…These include failure to seek help, unavailability of regular screening programmes for patients suspected of having T1DM, inability to make a formal diagnosis, inadequate and inappropriate care exacerbated by the lack of equipment, facilities and professionals, e.g. Ghana currently has less than fifteen endocrinologists, poor knowledge among patients and parents, frequent episodes of hypoglycaemia exacerbated by a lack of insulin and the cost of insulin as well as monitoring sticks and syringes, poor storage of insulin, poor adherence to treatments and poor eating habits as well as cultural aspects of care (1,6,20,24,43,44,62,63,80,(95)(96)(97)(98)(99)(100)(101)(102)(103)(104). The WHO in 2015 found that in SSA only 51% of the countries had metformin routinely available and only 40% had insulin readily available, well below the 80% target (1, 105).…”