Diabetes & Metabolism Journal

Original Article

Severe Hypoglycemia Is a Serious Complication and Becoming an Economic Burden in Diabetes: Won Chul Ha, Su Jin Oh, Ji Hyun Kim, Jung Min Lee, Sang Ah Chang, Tae Seo Sohn, Hyun Shik Son; Diabetes Metab J. 2012;36(4):280-284. Published online August 20, 2012; DOI: https://doi.org/10.4093/dmj.2012.36.4.280

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Background

The prevalence of hypoglycemia is increasing due to the growing incidence of diabetes and the latest strict guidelines for glycated hemoglobin (HbA1c) levels under 7%. This study examined the clinical characteristics, causal factors, and medical costs of severely hypoglycemic patients in an emergency room (ER) of Uijeongbu St. Mary's Hospital.

Methods

The study consisted of a retrospective analysis of the characteristics, risk factors, and medical costs of 320 severely hypoglycemic patients with diabetes who presented to an ER of Uijeongbu St. Mary's Hospital from January 1, 2006 to December 31, 2009.

Results

Most hypoglycemic patients (87.5%, 280/320) were over 60 years old with a mean age of 69.5±10.9 years and a mean HbA1c level of 6.95±1.46%. Mean serum glucose as noted in the ER was 37.9±34.5 mg/dL. Renal function was decreased, serum creatinine was 2.0±2.1 mg/dL and estimated glomerular filtration rate (eGFR) was 48.0±33.6 mL/min/1.73 m². In addition, hypoglycemic patients typically were taking sulfonylureas or insulin and a variety of other medications, and had a long history of diabetes.

Conclusion

Severe hypoglycemia is frequent in older diabetic patients, subjects with low HbA1c levels, and nephropathic patients. Therefore, personalized attention is warranted, especially in long-term diabetics with multiple comorbidities who may not have been properly educated or may need re-education for hypoglycemia.

Citations

Citations to this article as recorded by

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Yu-Jang Su, Yen-Chun Lai, Chia-Jung Liao
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Gyuri Kim, Yong-ho Lee, Mi Hye Han, Eui-Kyung Lee, Chong Hwa Kim, Hyuk Sang Kwon, In Kyung Jeong, Eun Seok Kang, Dae Jung Kim, Massimo Pietropaolo
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Response

Response: The Effect of an Angiotensin Receptor Blocker on Arterial Stiffness in Type 2 Diabetes Mellitus Patients with Hypertension (Diabetes Metab J 2011;35:236-42): Ji Hyun Kim, Su Jin Oh, Jung Min Lee, Eun Gyoung Hong, Jae Myung Yu, Kyung Ah Han, Kyung Wan Min, Hyun Shik Son, Sang Ah Chang; Diabetes Metab J. 2011;35(4):429-430. Published online August 31, 2011; DOI: https://doi.org/10.4093/dmj.2011.35.4.429

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Original Articles

The Effect of an Angiotensin Receptor Blocker on Arterial Stiffness in Type 2 Diabetes Mellitus Patients with Hypertension: Ji Hyun Kim, Su Jin Oh, Jung Min Lee, Eun Gyoung Hong, Jae Myung Yu, Kyung Ah Han, Kyung Wan Min, Hyun Shik Son, Sang Ah Chang; Diabetes Metab J. 2011;35(3):236-242. Published online June 30, 2011; DOI: https://doi.org/10.4093/dmj.2011.35.3.236

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7 Crossref

Abstract PDF PubReader

Background

Hypertension and type 2 diabetes mellitus are major risk factors for cardiovascular disease. This study analyzed the changes in central aortic waveforms and pulse wave velocity as well as related parameters after treatment with valsartan, an angiotensin II type 1 receptor blocker, in patients with type 2 diabetes and hypertension.

Methods

We used pulse wave analysis to measure central aortic waveform in a total of 98 subjects. In 47 of these patients, pulse wave velocity measurements were obtained before and after 12 weeks of treatment with valsartan.

Results

In the central aortic waveform analysis, the aortic pulse pressure and augmentation index were significantly decreased after valsartan treatment, as was the aortic pulse wave velocity. Factors contributing to the improvement in pulse wave velocity were the fasting blood glucose and haemoglobin A1c levels.

Conclusion

Short-term treatment with valsartan improves arterial stiffness in patients with type 2 diabetes and hypertension, and the glucose status at baseline was associated with this effect.

Citations

Citations to this article as recorded by

Mechanisms underlying the blood pressure‐lowering effects of empagliflozin, losartan and their combination in people with type 2 diabetes: A secondary analysis of a randomized crossover trial
Rosalie A. Scholtes, Charlotte M. Mosterd, Anne C. Hesp, Mark M. Smits, Hiddo J. L. Heerspink, Daniël H. van Raalte
Diabetes, Obesity and Metabolism.2023; 25(1): 198. CrossRef
Distinct effects of losartan and atenolol on vascular stiffness in Marfan syndrome
Ami B Bhatt, J Stewart Buck, Jonah P Zuflacht, Jessica Milian, Samoneh Kadivar, Kimberlee Gauvreau, Michael N Singh, Mark A Creager
Vascular Medicine.2015; 20(4): 317. CrossRef
The impact of angiotensin receptor blockers on arterial stiffness: a meta-analysis
Feng Peng, Hongming Pan, Bin Wang, Jinxiu Lin, Wenquan Niu
Hypertension Research.2015; 38(9): 613. CrossRef
Arterial stiffness in atherosclerotic renovascular hypertension
Ljiljana Fodor, Vedran Premužić, Vanja Ivković, Dražen Perkov, Mario Laganović, Tajana Željković Vrkić, Živka Dika, Marijana Živko, Bojan Jelaković
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Improvement of arterial wall characteristics by the low-dose fluvastatin and valsartan combination in type 1 diabetes mellitus patients
Vedran Savić, Barbara Eržen, Miodrag Janić, Mojca Lunder, Maja Boncelj, Karin Kanc, Andrej Janež, Mišo Šabovič
Diabetes and Vascular Disease Research.2013; 10(5): 420. CrossRef
The association between regional arterial stiffness and diabetic retinopathy in type 2 diabetes
Won Jun Kim, Cheol-Young Park, Se Eun Park, Eun Jung Rhee, Won Young Lee, Ki Won Oh, Sung Woo Park, Sun Woo Kim, SuJeong Song
Atherosclerosis.2012; 225(1): 237. CrossRef
Letter: The Effect of an Angiotensin Receptor Blocker on Arterial Stiffness in Type 2 Diabetes Mellitus Patients with Hypertension (Diabetes Metab J 2011;35:236-42)
Chul-Hee Kim
Diabetes & Metabolism Journal.2011; 35(4): 427. CrossRef

Association of Spot Urine Albumin-to-Creatinine Ratio and 24 Hour-Collected Urine Albumin Excretion Rate in Patients with Type 2 Diabetes Mellitus.: Jee In Lee, Hyuk Sang Kwon, Su Jin Oh, Jung Min Lee, Sang Ah Chang, Bong Yun Cha, Hyun Shik Son, Tae Seo Sohn; Korean Diabetes J. 2009;33(4):299-305. Published online August 1, 2009; DOI: https://doi.org/10.4093/kdj.2009.33.4.299

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Abstract PDF: BACKGROUND
Measuring urine albumin in diabetic patients is an important screening test to identify those individuals at high risk for cardiovascular disease and the progression of kidney disease. Recently, spot urine albumin-to-creatinine ratio (ACR) has replaced 24 hour-collected urine albumin excretion rate (AER) as a screening test for microalbuminuria given its comparative simplicity. The purpose of the current study was to evaluate the degree of correlation between AER and ACR in the normal, microalbuminuric and macroalbuminuric ranges, and to identify the lower limits of ACR for both genders. METHODS: A total of 310 type 2 diabetics admitted to one center were enrolled in the present study. Following the collection of a spot urine sample, urine was collected for 24 hours and albumin content was measured in both specimens. RESULTS: Mean patient age was 60.2 years. A total of 25.4% had microalbuminuria and 15.8% had macroalbuminuria. The data revealed a strongly positive correlation between AER and ACR across all ranges of albuminuria (R = 0.8). The cut-off value of ACR for 30 mg/day of AER by the regression equation was 24 microgram/mg for men, 42 microgram/mg for women and 31.2 microgram/mg for all patients. The diagnostic performance expressed as the area under the curve (AUC) was 0.938 (95% CI, 0.911-0.965) for ACR. ACR revealed a sensitivity of 84% and specificity of 84%, when a cut-off value of 31.2 microgram/mg was employed. CONCLUSION: ACR was highly correlated with AER, particularly in the range of microalbuminuria. The gender combined cut-off value of ACR in type 2 diabetic patients was determined to be 31.2 microg/mg However, additional studies of large outpatient populations, as opposed to the inpatient population used in the present study, are required to confirm the utility of this value.

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