title: The impact of severe hypoglycemia on renal impairment in type 2 diabetes.
abstract: OBJECTIVE
  Hypoglycemia has been reported to be associated with the development of microvascular events. Therefore, it is important to assess the impact of severe hypoglycemia on renal dysfunction in type 2 diabetes.
  
  
  METHODS
  We conducted a retrospective cohort study in a large tertiary care hospital from 2004 to 2013. A total of 101 patients with type 2 diabetes from the outpatient department with a history of severe hypoglycemia were studied. A random sample of 101 patients with type 2 diabetes without any hypoglycemia was selected by matching values of baseline blood creatinine, age, sex and diabetic duration.
  
  
  RESULTS
  Baseline blood creatinine (1.42 ± 0.75 mg/dL) significantly increased to 1.77 ± 1.26 and 1.93 ± 1.54 mg/dL, and baseline eGFR (44.37 ± 26.13 ml/min/1.73 m(2)) decreased to 41.28 ± 27.70 and 37.64 ± 24.54 ml/min/1.73 m(2) at the onset of hypoglycemia and the follow-up visit in severe hypoglycemia group; while no significant changes were observed in the group without any hypoglycemia. Multiple linear regression analysis showed that severe hypoglycemia is an independent risk factor for increase in blood creatinine and decrease in eGFR in all patients with type 2 diabetes, and that baseline creatinine, longer diabetic duration and lower HbA1c are risk factors for the deterioration of renal impairment in the group with severe hypoglycemia.
  
  
  CONCLUSIONS
  Our results showed that severe hypoglycemia is associated with deterioration of renal function in type 2 diabetes with chronic kidney disease and the patients with higher baseline creatinine and a longer diabetic duration could be more vulnerable to aggravation of renal function impairment.
authors.affiliation: Division of Endocrinology and Metabolism, Department of Internal Medicine, Kaohsiung Medical University Hospital, Taiwan.
authors.forename: Yu-Li
authors.initials: YL
authors.lastname: Lee
authors.affiliation: Arnold School of Public Health, University of South Carolina, USA.
authors.forename: Brian K
authors.initials: BK
authors.lastname: Chen
authors.affiliation: Division of Endocrinology and Metabolism, Department of Internal Medicine, Kaohsiung Medical University Hospital, Taiwan.
authors.forename: Kun-Der
authors.initials: KD
authors.lastname: Lin
authors.affiliation: Graduate Institute of Healthcare Administration, Kaohsiung Medical University, Kaohsiung, Taiwan.
authors.forename: Rong-Wei
authors.initials: RW
authors.lastname: Su
authors.affiliation: Division of Endocrinology and Metabolism, Department of Internal Medicine, Kaohsiung Medical University Hospital, Taiwan.
authors.forename: Mei-Yueh
authors.initials: MY
authors.lastname: Lee
authors.affiliation: Division of Endocrinology and Metabolism, Department of Internal Medicine, Kaohsiung Medical University Hospital, Taiwan; School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
authors.forename: Pi-Jung
authors.initials: PJ
authors.lastname: Hsiao
authors.affiliation: Division of Endocrinology and Metabolism, Department of Internal Medicine, Kaohsiung Medical University Hospital, Taiwan; School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; Center for Lipid and Glycomedicine Research, Kaohsiung Medical University, Kaohsiung, Taiwan. Electronic address: sjshin@kmu.edu.tw.
authors.forename: Shyi-Jang
authors.initials: SJ
authors.lastname: Shin
mesh_terms: D000368:Aged; D001786:Blood Glucose / Q000187:drug effects / Q000378:metabolism; D015331:Cohort Studies; D003404:Creatinine / Q000097:blood*; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy*; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D007003:Hypoglycemia / Q000097:blood / Q000139:chemically induced / Q000150:complications*; D015994:Incidence; D008297:Male; D051436:Renal Insufficiency, Chronic / Q000097:blood / Q000453:epidemiology / Q000209:etiology*; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D013624:Taiwan / Q000453:epidemiology
chemical_list: D001786:Blood Glucose; D003404:Creatinine
keywords: Diabetic nephropathy; Hypoglycemia; Type 2 diabetes