Biochemical Hypoglycemia in Type 2 Diabetes Mellitus

Biochemical Hypoglycemia can complicate diabetes mellitus management.This is a five years retrospective study of 352 hypoglycemic episodes (HE) occurring in 125 type 2 diabetes mellitus (T2DM) patients attending three departments in Lagos University Teaching Hospital (LUTH) LagosNigeria.The 3 departments involved are medicine department clinical pathology department and family medicine departments. A total of 369 casefiles were looked into.In literature Ademolus Classification of Hypoglycemia ACH has been used across the globe in diabetic patients. The first attempt to use ACH outside the African continent was in December 2015 by a group of researchers In Massachusetts General Hospital Boston Massachusetts and Harvard Medical School Boston Massachusetts United States of America who were working on hypoglycemia in diabetes as a coronary artery disease risk factor in patient at elevated vascular risk.In this studyit is clear that of the 11 HE recognised as been severe by ACH only one was recognised by American Diabetes Association / European Association for the Study of Diabetes (ADA/EASD) 2018 hypoglycemia classification despite the fact that all the 11 HE had dangerously low blood sugar values all less than 40mg/dl in T2DM patients! This shows that ADA/EASD classification placed importance on clinical symptoms of hypoglycemia to the detriment of dangerously low biochemical values which is highly dangerous for the T2DM patient brain which have a higher reset for its optimal glucose level of operation compared to the general population! The clustering of hypoglycemia between 65 to 70 mg/dl seen in this study is a finding that support ACH and give it an edge over ADA/EASD 2018 classification in that when hypoglycemia is not quickly recognised by way of definition at the level of 70mg/dl then tendency to populate the blood sugar range of 65-70mg/dl in T2DM is more but if hypoglycemia at 70mg/dl is quickly recognised and addressed this progression further in terms of decrease in blood sugar value will quickly be addressed and prevented.Point of care testing have revolutionarized the practice of clinical pathology globally in the last few decades especially since the turn of this 21st century! Technological advancement have made clinical chemistry practice less cumbersome.In this Nigerian study carried out in LUTH it is clear that more HE occurred in in-patients than out patients.The peak period for hypoglycemia could be described as in the morning with 201 HE representing 57.1% of all cases in this study.In LUTH recurrent hypoglycemia is four and half times as common as one off or one episode of hypoglycemia.The overall analysis of HE across the 3 departments still have grade 1 as the commonest mode of presentation with 73% grade 2 was the second commonest with 23.6%. Severe hypoglycemia which is grade 3 forms only 3.4% of cases.. Grade 4 hypoglycemia was not recorded within the study period in T2DM.All levels of hypoglycemia described by ADA/EASD 2018 hypoglycemia classification were described in this study they include 71.3% occurring as level one 23.7% representing level 2 and 4.8% representing level 3.The positive pearson correlation between ACH and ADA/EASD 2018 classification of hypoglycemia were still preserved when the 3 departments data were combined for analysis. The correlation at p-value 0.01 level as been significant at 2-tailed is 0.727.The practice of correlating point of care findings on glucometer reading with laboratory analysis is important. The concept of hypoglycemia in T2DM cannot be overemphasized as it occurs at different level of severity Therefore regular or periodic check on the trend of this complication of diabetes mellitus management is important in tertiary institutions..