Are we missing hypoglycaemia? Elderly patients with insulin-treated diabetes present to primary care frequently with non-specific symptoms associated with hypoglycaemia. Issue 2 (April 2018)

• Record Type: Journal Article
• Authors: Hope, Suzy V.; Taylor, Phil J.; Shields, Beverley M.; Hattersley, Andrew T.; Hamilton, Willie
• Is Part Of: Primary care diabetes. Volume 12:Issue 2(2018)
• Page Start: 139
• Page End: 146
• Publication Date: 2018-04
• Subjects: Elderly -- Hypoglycaemia -- Diagnosis -- Symptoms -- Insulin -- Falls; Diabetes -- Periodicals; 616.462
• DOI: 10.1016/j.pcd.2017.08.004
• Languages: English
• ISSNs: 1751-9918

Abstract

Highlights: Non-specific symptoms make hypoglycaemia recognition difficult in older patients Patients aged >65 commonly present to primary care with non-specific symptoms Those with documented hypos present more on other occasions with non-specific symptoms, which could represent unrecognised hypoglycaemia Nausea, falls & unsteadiness were more common in these patients. Abstract: Introduction: We assessed if patients with known hypoglycaemia present on other occasions with non-specific symptoms associated with (but not diagnosed as) hypoglycaemia, potentially representing missed hypoglycaemia. Methods: 335 primary care records (5/2/12-4/2/13) from patients aged >65 (79 on insulin, 85 on sulphonylureas, 121 on metformin only, 50 without diabetes) were assessed for hypoglycaemia episodes and consultations with non-specific symptoms, "hypo clues". Results: 27/79(34%) insulin-treated patients had >1 documented hypoglycaemia episode, compared to 4/85(5%) sulphonylurea-treated patients, 2/121(2%) metformin-only treated patients, and none without diabetes, p < 0.001. "Hypo clue" consultations were common: 1.37 consultations/patient/year in insulin-treated patients, 0.98/patient/year in sulphonylurea-treated, 0.97/patient/year in metformin only-treated, and 0.78/patient/year in non-diabetic patients, p = 0.34. In insulin-treated patients with documented hypoglycaemia, 20/27(74%) attended on another occasion with a "hypo clue" symptom, compared to 21/52(40%) of those without hypoglycaemia, p = 0.008. No significant difference in the other treatment groups. Nausea, falls and unsteadiness were the most discriminatory symptoms: 7/33(21%) with hypoglycaemia attended on another occasion with nausea compared to 14/302(5%) without hypoglycaemia, p = 0.002; 10/33(30%) vs 36/302(12%) with falls, p = 0.007; and 5/33(15%) vs 13/302(4%) with unsteadiness, p = 0.023. Conclusions: Non-specific symptoms are common in those >65 years. In insulin-treated patients at high hypoglycaemia risk, nausea, falls and unsteadiness should prompt consideration of hypoglycaemia.