ปัจจัยเสี่ยงของการเกิดภาวะน้ำตาลในเลือดต่ำซ้ำในผู้ป่วยเบาหวาน  โรงพยาบาลเชียงรายประชานุเคราะห์ จังหวัดเชียงราย

สิปปากร ปินชัย

Authors

สิปปากร ปินชัย Chirangrai Prachanukroh Hospital

Keywords:

Type 2 diabetes mellitus, Recurrent hypoglycemia, Hypoglycemia

Abstract

Background: Severe hypoglycemia is a life-threatening condition and a major barrier to appropriate medication adherence, leading to poor glycemic control and subsequent complications. Consequently, this study aimed to investigate the risk factors associated with recurrent hypoglycemia among diabetic patients at Chiangrai Prachanukroh Hospital. The findings will be utilized to develop appropriate healthcare systems, prevent recurrent episodes, reduce mortality rates, and improve the long-term management of diabetic patients.

Objective: To determine the incidence and risk factors associated with recurrent hypoglycemia within 6 months in diabetic patients at Chiangrai Prachanukroh Hospital.

Methods: This retrospective cohort study reviewed the medical records of diabetic patients presenting with hypoglycemia at the emergency department and inpatient wards of Chiangrai Prachanukroh Hospital between January 1st, 2023, and December 31st, 2024.

Results: Among a total of 241 patients, the incidence of recurrent hypoglycemia within 6 months was 25.31% (61 patients). Recurrent hypoglycemia group had a significantly higher proportion of a history of severe hypoglycemia (86.88% vs. 68.33%; p = 0.004), a higher proportion of insulin use (80.32% vs. 61.11%; p = 0.005), a higher utilization of high-dose insulin ≥1.0 unit/kg (32.78% vs. 16.66%; p = 0.007), a higher median HbA1C level (7.80% vs. 7.20%; p = 0.045), and a higher rate of skipping the prior meal (27.86% vs. 15.00%; p = 0.025). Multivariable analysis revealed that a history of severe hypoglycemia was the most significant independent risk factor for recurrence (AOR = 2.92; 95% CI: 1.26–6.78; p = 0.013), and a higher BMI was associated with a decreased likelihood of recurrent events (AOR = 0.93; 95% CI: 0.87–0.99; p = 0.019). Additionally, the use of sulfonylureas was associated with a reduced risk of recurrence (AOR = 0.44; 95% CI: 0.22–0.91; p = 0.026), reflecting clinical adjustments and medication de-escalation by physicians for high-risk patients.

Conclusions and recommendations: The incidence of recurrent hypoglycemia in diabetic patients within 6 months was 25.31%. A history of severe hypoglycemia and a low BMI are important clinical predictors. These findings emphasize the necessity of individualized risk assessment, medication reconciliation and adjustment prior to discharge, close clinical follow-up, and the promotion of self-monitoring of blood glucose to prevent recurrent events.

Keywords: Type 2 diabetes mellitus, Recurrent hypoglycemia, Hypoglycemia

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