Study: Hypoglycemic episodes ‘frequent, severe’ in patients with CKD, type 2 diabetes
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Results of a prospective, observational study showed that patients with chronic kidney disease and type 2 diabetes experienced frequent hypoglycemic episodes, many of which were deemed prolonged and severe.
“Glycemic management in patients with type 2 diabetes mellitus (T2DM) and chronic kidney disease (CKD) can become complicated,” Susana Hong, MD, of the Donald and Barbara Zucker School of Medicine at Hofstra/Northwell in New York, and colleagues wrote. “One factor that may impact treatment is hypoglycemia. Hypoglycemia risk may be increased in CKD by several biologic processes.”
Building on the results of a previous study which found a frequent occurrence of hypoglycemia in patients with CKD and type 2 diabetes who were taking sulfonylurea or insulin, researchers here did not require patients to be on medications known to cause hypoglycemia.
“We believed that it was important to study a broader CKD population including those treated with other diabetic medications or no diabetic medications,” they wrote.
To do this, Hong and colleagues included 80 patients with type 2 diabetes and CKD, excluding those with end-stage kidney disease who were on dialysis. Patients wore a continuous glucose monitor for up to 14 days (mean, 12.7 days). Researchers monitored the frequency of hypoglycemic episodes, which they defined as a reduced glucose concentration (<70 mg/dL) lasting at least 15 minutes. Severity of hypoglycemia and risk factors for its development were also considered.
Hypoglycemic events occurred in 76.25% of patients with glucose of less than 70 mg/dL and in 61% of those with glucose of less than 60 mg/dL.
Prolonged hypoglycemic events (defined as continuous glucose monitoring glucose of <54 mg/dL for 120 consecutive minutes) occurred in 31 patients (38.8%), equaling 118 total events.
The researchers observed that most hypoglycemic episodes occurred overnight, from 1:00 a.m. until 9:00 a.m.
In addition, 10 factors were identified that appeared to increase hypoglycemic risk. These included increased age, lower HbA1C and treatment with insulin, with patients not currently treated with insulin having a 44% lower risk of hypoglycemia. Hong and colleagues noted HbA1C and insulin are two modifiable risk factors.
“Clinicians should monitor and be vigilant for the occurrence of hypoglycemia in CKD,” the researchers concluded. “Decisions as to Hba1c targets in these patients should weigh hypoglycemia risk, and a higher level may often be justified. Further research should be performed in larger cohorts to more completely define the problem of hypoglycemia in this patient population.”
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