Are we missing hypoglycaemia? Elderly patients with insulin-treated diabetes present to primary care frequently with non-specific symptoms associated with hypoglycaemia
Hope, SV; Taylor, PJ; Shields, BM; et al.Hattersley, AT; Hamilton, W
Date: 11 September 2017
Journal
Primary Care Diabetes
Publisher
Elsevier
Publisher DOI
Abstract
Introduction
We assessed if patients with known hypoglycaemia present on other occasions with non-specific symptoms associated with (but not diagnosed as) hypoglycaemia, potentially representing missed hypoglycaemia.
Methods
335 primary care records (5/2/12-4/2/13) from patients aged >65 (79 on insulin, 85 on sulphonylureas, ...
Introduction
We assessed if patients with known hypoglycaemia present on other occasions with non-specific symptoms associated with (but not diagnosed as) hypoglycaemia, potentially representing missed hypoglycaemia.
Methods
335 primary care records (5/2/12-4/2/13) from patients aged >65 (79 on insulin, 85 on sulphonylureas, 121 on metformin only, 50 without diabetes) were assessed for hypoglycaemia episodes and consultations with non-specific symptoms, “hypo clues”.
Results
27/79(34%) insulin-treated patients had >1 documented hypoglycaemia episode, compared to 4/85(5%) sulphonylurea-treated patients, 2/121(2%) metformin-only treated patients, and none without diabetes, p < 0.001.
“Hypo clue” consultations were common: 1.37 consultations/patient/year in insulin-treated patients, 0.98/patient/year in sulphonylurea-treated, 0.97/patient/year in metformin only-treated, and 0.78/patient/year in non-diabetic patients, p = 0.34. In insulin-treated patients with documented hypoglycaemia, 20/27(74%) attended on another occasion with a “hypo clue” symptom, compared to 21/52(40%) of those without hypoglycaemia, p = 0.008. No significant difference in the other treatment groups.
Nausea, falls and unsteadiness were the most discriminatory symptoms: 7/33(21%) with hypoglycaemia attended on another occasion with nausea compared to 14/302(5%) without hypoglycaemia, p = 0.002; 10/33(30%) vs 36/302(12%) with falls, p = 0.007; and 5/33(15%) vs 13/302(4%) with unsteadiness, p = 0.023.
Conclusions
Non-specific symptoms are common in those >65 years. In insulin-treated patients at high hypoglycaemia risk, nausea, falls and unsteadiness should prompt consideration of hypoglycaemia.
Institute of Biomedical & Clinical Science
Collections of Former Colleges
Item views 0
Full item downloads 0
Except where otherwise noted, this item's licence is described as Creative Commons Attribution Licence CC-BY