title: Severe hypoglycemia in type II diabetes at Nakornping General Hospital: a study on clinical risk factors.
abstract: OBJECTIVE
  To study clinical risk factors of severe hypoglycemia in type II diabetes.
  
  
  METHODS
  Fifty-one type II diabetes with severe hypoglycemia admitted between October 2006 and September 2008 and 359 nonhypoglycemic type II diabetes were evaluated in this case-control study. Medical records were retrospective reviewed for age, sex, duration of diabetes, previous diabetes registration, concomitant diseases, HbA1c level and current diabetes therapy in both groups. Acute illness, blood glucose, hypoglycemic episodes, symptoms and length of stay (LOS) were assessed in hypoglycemic group. Univariate and multivariate logistic regression were used to determine risk factors of severe hypoglycemia.
  
  
  RESULTS
  Fifty-one hypoglycemic and 359 nonhypoglycemic patients were analyzed. The authors found that 40% of severe hypoglycemic cases were recurrent. The average LOS was six days. Intercurrent illness was the major leading cause of hypoglycemia (54.9%). Mean blood glucose level was 37.2 mg/dl (SD = 13.5). Twenty-three of fifty-one (45%) patients presented with unconsciousness. Predisposing risk factors associated with severe hypoglycemia were old age (p = 0.026), insulin therapy (p = 0.001), cirrhosis (p = 0.020), cerebrovascular disease (p = 0.040), and no diabetes registry (p = 0.015). Sex, HbA1c level, hypertension and chronic kidney disease were not risk factors associated with severe hypoglycemia.
  
  
  CONCLUSIONS
  Risk factors associated with severe hypoglycemia in type II diabetes were elderly, insulin therapy, cirrhosis, previous cerebrovascular disease, lack of standard diabetic care and team approach. Self-monitoring of blood glucose and individual case management should be considered in those with previous hypoglycemic events.
authors.affiliation: Department of Internal Medicine, Nakornping Hospital, Chiang Mai, Thailand. tippayankpcm@hotmail.com
authors.forename: Tippaya
authors.initials: T
authors.lastname: Sanchai
authors.forename: Jayanton
authors.initials: J
authors.lastname: Patumanond
mesh_terms: D000367:Age Factors; D000368:Aged; D016022:Case-Control Studies; D015897:Comorbidity; D003924:Diabetes Mellitus, Type 2 / Q000150:complications*; D005260:Female; D006769:Hospitals, General; D006801:Humans; D007003:Hypoglycemia / Q000453:epidemiology*; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D007328:Insulin / Q000627:therapeutic use; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012307:Risk Factors; D013785:Thailand / Q000453:epidemiology
chemical_list: D007004:Hypoglycemic Agents; D007328:Insulin