Frequency and Associated Factors of Hypoglycemic Symptoms and Fear of Hypoglycemia in Elderly Patient with Type 2 Diabetes at Primary Care Unit of Songklanagarind Hospital

Abstract

Objective: To determine the frequency of symptomatic hypoglycemia and its associated factors and fear of hypoglycemia in a population of elderly patient with type 2 diabetes at primary care unit of Songklanagarind Hospital. Methodology: This cross-sectional study was conducted from July to October 2018 at primary care unit of Songklanagarind Hospital. The participants aged 60 and older with type 2 diabetes were included. The socio-demographic characteristic questionnaire was interviewed by a re­searcher or research assistants. Baseline clinical data, included body weight, height, underlying disease, duration of diabetes, complications of diabetes (diabetic retinopathy, diabetic nephropathy, cerebrovas­cular, peripheral vascular, neurovascular and diabetic foot complication), HbA1c, fasting plasma glucose, type and dose of glucose lowering drugs, were reviewed from the hospital information system (HIS). The participants were asked on their experiences of hypoglycemic symptoms in the previous month. Fear of hypoglycemia was measured by the Thai version of Hypoglycemia Fear Survey (HFS) covering behavior subscale (HFS-B) and worry subscale (HFS-W). The higher scores indicate higher fear of hypoglycemia. Chi-square, Wilcoxon, and Fisher tests were applied to study significant variables. Logistic regression analyses were performed to evaluate the associations between associated factors and hypoglycemic symptoms. Results: Overall, 160 participants were involved (mean age 68.6 ± 6.1 years, 53.8% females, diabetes duration of 10.5 ± 6.4 years, 57.5% diabetic complications, 7.5 ± 1.8% HbA1c), of whom 30% reported hypoglycemic symptoms. The associated factors of hypoglycemic symptoms were diabetic complications (aOR = 2.75; 95% CI 1.23 - 6.14; p = 0.012), glipizide use (aOR = 5.03; 95% CI 1.99 - 12.71; p < 0.001) and fasting plasma glucose (aOR = 0.97; 95% CI 0.96 - 0.99; p < 0.001). The mean of hypogly­cemia fear survey score was 16.9 ± 16. The score on the fear of hypoglycemia (HFS) and worry subscale (HFS-W) for the patients with more frequent hypoglycemia episodes in the previous month (>2 episodes) was significantly greater than another group (1-2 episodes) (p = 0.006 and 0.002), indicating a greater degree of fear of hypoglycemia in the first group. Conclusion: The occurrence of symptoms of hypoglycemia is one of complications in the elderly with type 2 diabetes and their presence is asso­ciated with complications of diabetes and glipizide use. Frequent symptoms can have a negative impact on fear of hypoglycemia. Minimizing the risk of hypoglycemia represents a high priority in the diabetes treatment of the elderly people.