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One in four patients with diabetes reports hypoglycemia while fasting
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More than one-quarter of patients with diabetes experienced fasting-induced hypoglycemia while fasting for laboratory tests, according to a study recently published in the International Journal of Clinical Medicine.
“In addition to the inconvenience and questionable necessity of fasting for lipid profiles in clinical practice, there is ongoing discussion regarding the safety of such fasting in patients with diabetes,” Saleh Aldasouqi, MD, of the division of endocrinology, department of medicine at Michigan State University College of Human Medicine, East Lansing, Michigan, and colleagues wrote. “As recently reported, patients with diabetes on hypoglycemic medications are especially vulnerable to fasting that can increase their risk for hypoglycemia especially if they are not adequately prepared for fasting. We recently describe a ‘novel’ form of hypoglycemia referred to as fasting-evoked en-route hypoglycemia in diabetes or FEEHD. While FEEHD has been described recently in two small studies and a case series, the exact prevalence of FEEHD remains largely unknown.”
The researchers administered a two-page survey to 166 adults at four clinical sites in the Lansing and East Lansing area. The survey was directed at patients with diabetes who had been prescribed diabetes medication, and asked patients whether they had ever experienced hypoglycemia while fasting for a laboratory test.
Mean age was 55.3 years, 79 (47.6%) participants were women, 119 (71%) had type 2 diabetes, 24 (14.7%) took at least one oral hypoglycemic agent, 58 (34.9%) reported receiving insulin or other injectable medicines without oral hypoglycemic agents, and 83 (50%) took both. Patients had received a mean 2.4 fasting lab orders in the past year, and 103 (62%) reported between one and four all-cause hypoglycemic episodes in the previous year.
Among the cohort, 45 (27.1%) reported at least one FEEHD event. Of those who experienced a hypoglycemic event, only 31.1% reported such incidents to their physicians, and only 40% of FEEHD events prompted health care providers to make medication changes, the researchers noted.
“Although this is a pilot, non-randomized study, and despite the study’s limitations, it is hoped that this pilot study triggers further studies of larger samples and improved designs to address the prevalence of FEEHD in other clinical settings and in the population,” the researchers wrote. “Finally, it is hoped that health organizations, especially diabetes organizations, take a note of this issue and develop specific educational guidelines to prevent FEEHD.” – by Andy Polhamus
Disclosure: Aldasouqi reports speaking fees from Janssen Pharmaceutical and Sanofi Pharmaceutical. Please see the full study for a complete list of all other researchers’ relevant financial disclosures.
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