A Study on Clinical Presentations, Background Illness and Precipitating Factors of Hypoglycaemia in a Tertiary Care Centre

Authors

  • Soumya Das Senior Resident, M.B.B.S, MD (Internal Medicine), DNB (Internal Medicine), Department of General Medicine, Nil Ratan Sircar Medical College and Hospital, Entally, Kolkata – 700014
  • Milon Chakroborty Professor, Head of the Department of General Medicine, M.B.B.S, MD (Internal Medicine), Department of General Medicine, Nil Ratan Sircar Medical College and Hospital, Entally, Kolkata – 700014
  • Monali Dutta Senior Resident, MBBS, MD (Pediatrics), Department of Pediatrics, Gandhi Medical College, Royal Market, Bhopal, Madhya Pradesh 462001

Abstract

Introduction: Hypoglycemia is a common and potentially life-threatening condition encountered in medical wards. It presents with varied clinical symptoms and is influenced by multiple underlying illnesses and precipitating factors. Understanding the clinical spectrum, associated comorbidities, and precipitating causes is crucial for early diagnosis and management. Aims: Aims to document clinical presentations, identify background illnesses and precipitating factors, and follow the illness course during hospital stay in each hypoglycemia case. Materials and Methods: This hospital based single Centre study was conducted in the N.R.S. Medical College and Hospital Kolkata (Department of General Medicine Ward from March 2020 to August 2021.This study included 100 patients Result: Among the 100 patients, the mean age was 48.22 ± 3.65 years, with a male predominance (64%). Common clinical features included cold clammy extremities (41%), convulsions (24%), and loss of consciousness (35%). Drug-induced hypoglycemia was the leading diagnosis (73%), followed by sepsis (19%) and alcohol-induced hypoglycemia (8%). Five patients (5%) died during hospitalization. Significant differences between death and survival groups included higher total leukocyte count, neutrophil percentage, CRP, urea, and urine albumin-creatinine ratio, and lower lymphocyte percentage and cortisol levels in those who died. Imaging showed cerebral edema was more common in deceased patients. No significant differences were found in age, sex, comorbidities, or drug history between groups. Conclusion: Hypoglycemia in hospitalized patients is associated with diverse clinical presentations and underlying conditions. Elevated inflammatory markers, renal dysfunction, low cortisol levels, and cerebral edema are linked to worse outcomes. Early identification of these factors may improve management and prognosis.

Keywords:

Hypoglycemia, Clinical Presentation, Comorbidity, Drug-Induced Hypoglycaemia

References

1. American Diabetes Association. Standards of medical care in diabetes-2013. Diabetes Care. 2013;36(Suppl 1):S11-66.

2. ADVANCE Collaborative Group. Intensive blood glucose control and vascular outcomes in patients with type 2 diabetes. N Engl J Med. 2008;358(24):2560-72.

3. Duckworth W, Abraira C, Moritz T, Reda D, Emanuele N, Reaven PD, et al. Glucose control and vascular complications in veterans with type 2 diabetes. N Engl J Med. 2009;360(2):129-39.

4. Action to Control Cardiovascular Risk in Diabetes Study Group. Effects of intensive glucose lowering in type 2 diabetes. N Engl J Med. 2008;358(24):2545-59.

5. Kim JT, Oh TJ, Lee YA, Bae JH, Kim HJ, Jung HS, et al. Increasing trend in the number of severe hypoglycemia patients in Korea. Diabetes Metab J. 2011;35(2):166-72.

6. Reichard P, Britz A, Carlsson P, Cars I, Lindblad L, Nilsson BY, et al. Metabolic control and complications over 3 years in patients with insulin dependent diabetes (IDDM): The Stockholm Diabetes Intervention Study (SDIS). J Intern Med. 1990;228(6):511-7.

7. Noh RM, Graveling AJ, Frier BM. Medically minimising the impact of hypoglycemia in type 2 diabetes: A review. Expert Opin Pharmacother. 2011;12(14):2161-75.

8. Griesdale DE, de Souza RJ, van Dam RM, Heyland DK, Cook DJ, Malhotra A, et al. Intensive insulin therapy and mortality among critically ill patients: A meta-analysis including NICE-SUGAR study data. CMAJ. 2009;180(8):821-7.

9. UK Hypoglycaemia Study Group. Risk of hypoglycaemia in types 1 and 2 diabetes: Effects of treatment modalities and their duration. Diabetologia. 2007;50(6):1140-7.

10. Akram K, Pedersen-Bjergaard U, Carstensen B, Borch-Johnsen K, Thorsteinsson B. Frequency and risk factors of severe hypoglycaemia in insulin-treated Type 2 diabetes: A cross-sectional survey. Diabet Med. 2006;23(7):750-6.

11. Leese GP, Wang J, Broomhall J, Kelly P, Marsden A, Morrison W, et al. Frequency of severe hypoglycaemia requiring emergency treatment in type 1 and type 2 diabetes: A population based study of health service resource use. Diabetes Care. 2003;26(4):1176-80.

12. Babu MR, D'Souza JL, Susheela C. Study of incidence, clinical profile and risk factors of neonatal hypoglycemia in a tertiary care hospital. Int J Pediatr Res. 2016;3(10):753-8.

13. Cryer PE, Axelrod L, Grossman AB, Heller SR, Montori VM, Seaquist ER, et al. Evaluation and management of adult hypoglycemic disorders: an Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. 2009;94(3):709-28.

14. Kagansky N, Levy S, Rimon E, Cojocaru L, Fridman A, Ozer Z, et al. Hypoglycemia as a predictor of mortality in hospitalized elderly patients. Arch Intern Med. 2003;163(15):1825-9.

15. NICE-SUGAR Study Investigators. Hypoglycemia and risk of death in critically ill patients. N Engl J Med. 2012;367(12):1108-18.

16. Segel SA, Paramore DS, Cryer PE. Hypoglycemia-associated autonomic failure in advanced type 2 diabetes. Diabetes. 2002;51(3):724-33.

17. Jørgensen HV, Pedersen-Bjergaard U, Rasmussen ÅK, Borch-Johnsen K. The impact of severe hypoglycemia and impaired awareness of hypoglycemia on relatives of patients with type 1 diabetes. Diabetes Care. 2003;26(4):1106-9.

Published

2025-08-28
Statistics
Abstract Display: 0
PDF Downloads: 0

Issue

Vol. 16 No. 9 (2025): Volume16,Issue9

Section

Articles