Palabras clave
hipoglucemia
diabetes mellitus
insulina
urgencias médicas
diabetes mellitus
insulina
urgencias médicas
Cómo citar
Chaves, W., Martínez, L., Díaz, D., Hernández, D., & Sanabria, M. (2019). Hipoglucemia en pacientes con diabetes mellitus en los servicios de urgencias de dos hospitales de Bogotá, 2015-2017. Revista Colombiana De Endocrinología, Diabetes &Amp; Metabolismo, 6(4), 269–276. https://doi.org/10.53853/encr.6.4.545
Resumen
Introducción: desde el punto de vista geno y fenotípico, la población diabética es heterogénea, lo que hace que algunos grupos especiales sean más susceptibles a complicaciones durante el tratamiento. Dentro de estas complicaciones, la hipoglucemia, es un motivo frecuente de consulta; sin embargo, la información acerca de episodios de esta alteración es limitada.
Objetivo: determinar las características sociodemográficas y clínicas de los pacientes diabéticos con hipoglucemia en los servicios de urgencias del Hospital de San José y el Hospital Infantil Universitario de San José.
Metodología: evaluación a una cohorte retrospectiva de pacientes diabéticos con hipoglucemia en los servicios de urgencias, durante enero de 2015 a diciembre de 2017. Se hizo un análisis descriptivo de los factores demográficos, clínicos y terapéuticos de esta población. Los datos fueron recolectados de las historias clínicas y las características fueron analizadas mediante estadística descriptiva.
Resultados: dentro de los datos encontrados, 201 pacientes presentaron hipoglucemia al ingreso (12,5 %). Con una mediana de 70 años, el 85,5 % eran diabéticos tipo 2; de estos, 99 % tenían manejo con insulina; con mayor frecuencia usaron insulina glargina (58,1 %) e insulina glulisina (36,3 %). El 36,6 % usó medicamentos orales, principalmente biguanidas; y la combinación más frecuente fue insulina basal más insulina de corta acción, en el 56,7 %. La mediana de glucosa fue de 40,5 mg/dL y la prueba de hemoglobina glicosilada (HbA1c) fue de 6,7 %. La mortalidad hallada en esta población fue del 7,5 %.
Conclusiones: la prevalencia de hipoglucemia en este estudio fue baja. Los resultados podrían sugerir la falta de individualización al momento de escoger los tratamientos y los objetivos terapéuticos, lo que refleja un aumento de los episodios de hipoglucemia grave. Por lo tanto, se debe realizar un tratamiento centrado en el paciente, considerando la presencia de episodios previos, los antecedentes de enfermedad cardiovascular, las enfermedades concomitantes asociadas, el peso, el costo de los medicamentos y la edad.
Citas
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2. Emral R, Pathan F, Cortés CAY, El-Hefnawy MH, Goh S-Y, Gómez AM, et al. Self-reported hypoglycemia in insulin-treated patients with diabetes: Results from an international survey on 7289 patients from nine countries. Diabetes Res Clin Pract. 2017;134:17-28.
3. Seaquist ER, Anderson J, Childs B, Cryer P, Dagogo-Jack S, Fish L, et al. Hypoglycemia and diabetes: a report of a workgroup of the American Diabetes Association and the Endocrine Society. Diabetes Care. 2013;36(5):1384-95.
4. Leese GP, Wang J, Broomhall J, Kelly P, Marsden A, Morrison W, et al. Frequency of severe hypoglycemia requiring emergency treatment in type 1 and type 2 diabetes: a population-based study of health service resource use. Diabetes Care. 2003;26(4):1176-80.
5. Bonds DE, Miller ME, Bergenstal RM, Buse JB, Byington RP, Cutler JA, et al. The association between symptomatic, severe hypoglycaemia and mortality in type 2 diabetes: retrospective epidemiological analysis of the ACCORD study. BMJ. 2010;340:b4909.
6. Khunti K, Davies M, Majeed A, Thorsted BL, Wolden ML, Paul SK. Hypoglycemia and risk of cardiovascular disease and all-cause mortality in insulin-treated people with type 1 and type 2 diabetes: a cohort study. Diabetes Care. 2015;38(2):316-22.
7. Frier BM. Hypoglycaemia in diabetes mellitus: epidemiology and clinical implications. Nat Rev Endocrinol. 2014;10(12):711-22.
8. Action to Control Cardiovascular Risk in Diabetes Study Group, Gerstein HC, Miller ME, Byington RP, Goff DC, Bigger JT, et al. Effects of intensive glucose lowering in type 2 diabetes. N Engl J Med. 2008;358(24):2545-59.
9. Mathur S, Zammitt NN. Optimal glycaemic control in elderly people with type 2 diabetes: what does the evidence say?. Drug Safety BM. 2015;38(1).
10. Brito-Sanfiel M, Diago-Cabezudo J, Calderon A. Economic impact of hypoglycemia on healthcare in Spain. Expert Rev Pharmacoecon Outcomes Res. 2010;10(6):649-60.
11. Edridge CL, Dunkley AJ, Bodicoat DH, Rose TC, Gray LJ, Davies MJ, et al. Prevalence and Incidence of Hypoglycaemia in 532,542 People with Type 2 Diabetes on Oral Therapies and Insulin: A Systematic Review and MetaAnalysis of Population Based Studies. PloS One. 2015;10(6):e0126427.
12. Cryer PE, Axelrod L, Grossman AB, Heller SR, Montori VM, Seaquist ER, et al. Evaluation and management of adult hypoglycemic disorders: an Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. marzo de 2009;94(3):709-28.
13. Hex N, Bartlett C, Wright D, Taylor M, Varley D. Estimating the current and future costs of Type 1 and Type 2 diabetes in the UK, including direct health costs and indirect societal and productivity costs. Diabet Med J Br Diabet Assoc. 2012;29(7):855-62.
14. Zoungas S, Patel A, Chalmers J, de Galan BE, Li Q, Billot L, et al. Severe Hypoglycemia and Risks of Vascular Events and Death. N Engl J Med. 2010;363(15):1410-8.
15. Feinkohl I, Aung PP, Keller M, Robertson CM, Morling JR, McLachlan S, et al. Severe hypoglycemia and cognitive decline in older people with type 2 diabetes: the Edinburgh type 2 diabetes study. Diabetes Care. 2014;37(2):507-15.
16. Donnelly LA, Morris AD, Frier BM, Ellis JD, Donnan PT, Durrant R, et al. Frequency and predictors of hypoglycaemia in Type 1 and insulin-treated Type 2 diabetes: a population-based study. Diabet Med J Br Diabet Assoc. 2005;22(6):749-55.
17. UK Hypoglycaemia Study Group. Risk of hypoglycaemia in types 1 and 2 diabetes: effects of treatment modalities and their duration. Diabetologia. 2007;50(6):1140-7.
18. ter Braak EW, Appelman AM, van de Laak M, Stolk RP, van Haeften TW, Erkelens DW. Clinical characteristics of type 1 diabetic patients with and without severe hypoglycemia. Diabetes Care. 2000;23(10):1467-71.
19. Cecilia VR, San Cristóbal F, Jara P, López S, Trujillo J, Cecilia VR, et al. Caracterización de eventos de hipoglicemia en pacientes diabéticos y no diabéticos atendidos en un servicio de urgencia. Rev Médica Chile. 2017;145(11):1387-93.
20. Khunti K, Alsifri S, Aronson R, Cigrovski Berkovi? M, Enters-Weijnen C, Forsén T, et al. Rates and predictors of hypoglycaemia in 27 585 people from 24 countries with insulin-treated type 1 and type 2 diabetes: the global HAT study. Diabetes Obes Metab. 2016;18(9):907-15.
21. Papademetriou V, Lovato L, Doumas M, Nylen E, Mottl A, Cohen RM, et al. Chronic kidney disease and intensive glycemic control increase cardiovascular risk in patients with type 2 diabetes. Kidney Int. 2015;87(3):649-59.
22. ORIGIN Trial Investigators. Predictors of nonsevere and severe hypoglycemia during glucose-lowering treatment with insulin glargine or standard drugs in the ORIGIN trial. Diabetes Care. 2015;38(1):22-8.
23. Gubitosi-Klug RA, Braffett BH, White NH, Sherwin RS, Service FJ, Lachin JM, et al. Risk of Severe Hypoglycemia in Type 1 Diabetes Over 30 Years of Follow-up in the DCCT/EDIC Study. Diabetes Care. 2017;40(8):1010-6.
24. McAulay V, Deary IJ, Frier BM. Symptoms of hypoglycaemia in people with diabetes. Diabet Med J Br Diabet Assoc. 2001;18(9):690-705.
25. Hepburn DA, MacLeod KM, Pell AC, Scougal IJ, Frier BM. Frequency and symptoms of hypoglycaemia experienced by patients with type 2 diabetes treated with insulin. Diabet Med J Br Diabet Assoc. 1993;10(3):231-7.
26. Östenson CG, Geelhoed-Duijvestijn P, Lahtela J, Weitgasser R, Markert Jensen M, Pedersen-Bjergaard U. Self-reported non-severe hypoglycaemic events in Europe. Diabet Med J Br Diabet Assoc. 2014;31(1):92-101.
27. Orozco-Beltrán D, Artola S, Jansà M, Lopez de la Torre-Casares M, Fuster E. Impact of hypoglycemic episodes on health-related quality of life of type-2 diabetes mellitus patients: development and validation of a specific QoLHYPO© questionnaire. Health Qual Life Outcomes. 2018;16(1):52.
28. Rosenstock J, Fonseca V, Schinzel S, Dain M-P, Mullins P, Riddle M. Reduced risk of hypoglycemia with once-daily glargine versus twice-daily NPH and number needed to harm with NPH to demonstrate the risk of one additional hypoglycemic event in type 2 diabetes: Evidence from a long-term controlled trial. J Diabetes Complications. 2014;28(5):742-9.
29. Lipska KJ, Parker MM, Moffet HH, Huang ES, Karter AJ. Association of Initiation of Basal Insulin Analogs vs Neutral Protamine Hagedorn Insulin With Hypoglycemia-Related Emergency Department Visits or Hospital Admissions and With Glycemic Control in Patients With Type 2 Diabetes. JAMA. 2018;320(1):53-62.
30. Zinman B, Wanner C, Lachin JM, Fitchett D, Bluhmki E, Hantel S, et al. Empagliflozin, Cardiovascular Outcomes, and Mortality in Type 2 Diabetes. N Engl J Med. 2015;373(22):2117-28.
31. Marso SP, Poulter NR, Nissen SE, Nauck MA, Zinman B, Daniels GH, et al. Design of the liraglutide effect and action in diabetes: evaluation of cardiovascular outcome results (LEADER) trial. Am Heart J. 2013;166(5):823- 830.e5.
32. Fulcher G, Matthews DR, Perkovic V, de Zeeuw D, Mahaffey KW, Mathieu C, et al. Efficacy and safety of canagliflozin when used in conjunction with incretin-mimetic therapy in patients with type 2 diabetes. Diabetes Obes Metab. 2016;18(1):82-91.
33. Scirica BM, Bhatt DL, Braunwald E, Steg PG, Davidson J, Hirshberg B, et al. The design and rationale of the saxagliptin assessment of vascular outcomes recorded in patients with diabetes mellitus-thrombolysis in myocardial infarction (SAVOR-TIMI) 53 study. Am Heart J. 2011;162(5):818-825.e6.
34. Roumie CL, Min JY, Greevy RA, Grijalva CG, Hung AM, Liu X, et al. Risk of hypoglycemia following intensification of metformin treatment with insulin versus sulfonylurea. CMAJ Can Med Assoc J J Assoc Medicale Can. 2016;188(6):E104-12.
35. Davies MJ, D’Alessio DA, Fradkin J, Kernan WN, Mathieu C, Mingrone G, et al. Management of hyperglycaemia in type 2 diabetes, 2018. A consensus report by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD). Diabetologia. 2018;61(12):2461-98.
36. Barranco RJ, Gomez-Peralta F, Abreu C, Delgado M, Palomares R, Romero F, et al. Incidence and care-related costs of severe hypoglycaemia requiring emergency treatment in Andalusia (Spain): the PAUEPAD project. Diabet Med J Br Diabet Assoc. 2015;32(11):1520-6.
2. Emral R, Pathan F, Cortés CAY, El-Hefnawy MH, Goh S-Y, Gómez AM, et al. Self-reported hypoglycemia in insulin-treated patients with diabetes: Results from an international survey on 7289 patients from nine countries. Diabetes Res Clin Pract. 2017;134:17-28.
3. Seaquist ER, Anderson J, Childs B, Cryer P, Dagogo-Jack S, Fish L, et al. Hypoglycemia and diabetes: a report of a workgroup of the American Diabetes Association and the Endocrine Society. Diabetes Care. 2013;36(5):1384-95.
4. Leese GP, Wang J, Broomhall J, Kelly P, Marsden A, Morrison W, et al. Frequency of severe hypoglycemia requiring emergency treatment in type 1 and type 2 diabetes: a population-based study of health service resource use. Diabetes Care. 2003;26(4):1176-80.
5. Bonds DE, Miller ME, Bergenstal RM, Buse JB, Byington RP, Cutler JA, et al. The association between symptomatic, severe hypoglycaemia and mortality in type 2 diabetes: retrospective epidemiological analysis of the ACCORD study. BMJ. 2010;340:b4909.
6. Khunti K, Davies M, Majeed A, Thorsted BL, Wolden ML, Paul SK. Hypoglycemia and risk of cardiovascular disease and all-cause mortality in insulin-treated people with type 1 and type 2 diabetes: a cohort study. Diabetes Care. 2015;38(2):316-22.
7. Frier BM. Hypoglycaemia in diabetes mellitus: epidemiology and clinical implications. Nat Rev Endocrinol. 2014;10(12):711-22.
8. Action to Control Cardiovascular Risk in Diabetes Study Group, Gerstein HC, Miller ME, Byington RP, Goff DC, Bigger JT, et al. Effects of intensive glucose lowering in type 2 diabetes. N Engl J Med. 2008;358(24):2545-59.
9. Mathur S, Zammitt NN. Optimal glycaemic control in elderly people with type 2 diabetes: what does the evidence say?. Drug Safety BM. 2015;38(1).
10. Brito-Sanfiel M, Diago-Cabezudo J, Calderon A. Economic impact of hypoglycemia on healthcare in Spain. Expert Rev Pharmacoecon Outcomes Res. 2010;10(6):649-60.
11. Edridge CL, Dunkley AJ, Bodicoat DH, Rose TC, Gray LJ, Davies MJ, et al. Prevalence and Incidence of Hypoglycaemia in 532,542 People with Type 2 Diabetes on Oral Therapies and Insulin: A Systematic Review and MetaAnalysis of Population Based Studies. PloS One. 2015;10(6):e0126427.
12. Cryer PE, Axelrod L, Grossman AB, Heller SR, Montori VM, Seaquist ER, et al. Evaluation and management of adult hypoglycemic disorders: an Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. marzo de 2009;94(3):709-28.
13. Hex N, Bartlett C, Wright D, Taylor M, Varley D. Estimating the current and future costs of Type 1 and Type 2 diabetes in the UK, including direct health costs and indirect societal and productivity costs. Diabet Med J Br Diabet Assoc. 2012;29(7):855-62.
14. Zoungas S, Patel A, Chalmers J, de Galan BE, Li Q, Billot L, et al. Severe Hypoglycemia and Risks of Vascular Events and Death. N Engl J Med. 2010;363(15):1410-8.
15. Feinkohl I, Aung PP, Keller M, Robertson CM, Morling JR, McLachlan S, et al. Severe hypoglycemia and cognitive decline in older people with type 2 diabetes: the Edinburgh type 2 diabetes study. Diabetes Care. 2014;37(2):507-15.
16. Donnelly LA, Morris AD, Frier BM, Ellis JD, Donnan PT, Durrant R, et al. Frequency and predictors of hypoglycaemia in Type 1 and insulin-treated Type 2 diabetes: a population-based study. Diabet Med J Br Diabet Assoc. 2005;22(6):749-55.
17. UK Hypoglycaemia Study Group. Risk of hypoglycaemia in types 1 and 2 diabetes: effects of treatment modalities and their duration. Diabetologia. 2007;50(6):1140-7.
18. ter Braak EW, Appelman AM, van de Laak M, Stolk RP, van Haeften TW, Erkelens DW. Clinical characteristics of type 1 diabetic patients with and without severe hypoglycemia. Diabetes Care. 2000;23(10):1467-71.
19. Cecilia VR, San Cristóbal F, Jara P, López S, Trujillo J, Cecilia VR, et al. Caracterización de eventos de hipoglicemia en pacientes diabéticos y no diabéticos atendidos en un servicio de urgencia. Rev Médica Chile. 2017;145(11):1387-93.
20. Khunti K, Alsifri S, Aronson R, Cigrovski Berkovi? M, Enters-Weijnen C, Forsén T, et al. Rates and predictors of hypoglycaemia in 27 585 people from 24 countries with insulin-treated type 1 and type 2 diabetes: the global HAT study. Diabetes Obes Metab. 2016;18(9):907-15.
21. Papademetriou V, Lovato L, Doumas M, Nylen E, Mottl A, Cohen RM, et al. Chronic kidney disease and intensive glycemic control increase cardiovascular risk in patients with type 2 diabetes. Kidney Int. 2015;87(3):649-59.
22. ORIGIN Trial Investigators. Predictors of nonsevere and severe hypoglycemia during glucose-lowering treatment with insulin glargine or standard drugs in the ORIGIN trial. Diabetes Care. 2015;38(1):22-8.
23. Gubitosi-Klug RA, Braffett BH, White NH, Sherwin RS, Service FJ, Lachin JM, et al. Risk of Severe Hypoglycemia in Type 1 Diabetes Over 30 Years of Follow-up in the DCCT/EDIC Study. Diabetes Care. 2017;40(8):1010-6.
24. McAulay V, Deary IJ, Frier BM. Symptoms of hypoglycaemia in people with diabetes. Diabet Med J Br Diabet Assoc. 2001;18(9):690-705.
25. Hepburn DA, MacLeod KM, Pell AC, Scougal IJ, Frier BM. Frequency and symptoms of hypoglycaemia experienced by patients with type 2 diabetes treated with insulin. Diabet Med J Br Diabet Assoc. 1993;10(3):231-7.
26. Östenson CG, Geelhoed-Duijvestijn P, Lahtela J, Weitgasser R, Markert Jensen M, Pedersen-Bjergaard U. Self-reported non-severe hypoglycaemic events in Europe. Diabet Med J Br Diabet Assoc. 2014;31(1):92-101.
27. Orozco-Beltrán D, Artola S, Jansà M, Lopez de la Torre-Casares M, Fuster E. Impact of hypoglycemic episodes on health-related quality of life of type-2 diabetes mellitus patients: development and validation of a specific QoLHYPO© questionnaire. Health Qual Life Outcomes. 2018;16(1):52.
28. Rosenstock J, Fonseca V, Schinzel S, Dain M-P, Mullins P, Riddle M. Reduced risk of hypoglycemia with once-daily glargine versus twice-daily NPH and number needed to harm with NPH to demonstrate the risk of one additional hypoglycemic event in type 2 diabetes: Evidence from a long-term controlled trial. J Diabetes Complications. 2014;28(5):742-9.
29. Lipska KJ, Parker MM, Moffet HH, Huang ES, Karter AJ. Association of Initiation of Basal Insulin Analogs vs Neutral Protamine Hagedorn Insulin With Hypoglycemia-Related Emergency Department Visits or Hospital Admissions and With Glycemic Control in Patients With Type 2 Diabetes. JAMA. 2018;320(1):53-62.
30. Zinman B, Wanner C, Lachin JM, Fitchett D, Bluhmki E, Hantel S, et al. Empagliflozin, Cardiovascular Outcomes, and Mortality in Type 2 Diabetes. N Engl J Med. 2015;373(22):2117-28.
31. Marso SP, Poulter NR, Nissen SE, Nauck MA, Zinman B, Daniels GH, et al. Design of the liraglutide effect and action in diabetes: evaluation of cardiovascular outcome results (LEADER) trial. Am Heart J. 2013;166(5):823- 830.e5.
32. Fulcher G, Matthews DR, Perkovic V, de Zeeuw D, Mahaffey KW, Mathieu C, et al. Efficacy and safety of canagliflozin when used in conjunction with incretin-mimetic therapy in patients with type 2 diabetes. Diabetes Obes Metab. 2016;18(1):82-91.
33. Scirica BM, Bhatt DL, Braunwald E, Steg PG, Davidson J, Hirshberg B, et al. The design and rationale of the saxagliptin assessment of vascular outcomes recorded in patients with diabetes mellitus-thrombolysis in myocardial infarction (SAVOR-TIMI) 53 study. Am Heart J. 2011;162(5):818-825.e6.
34. Roumie CL, Min JY, Greevy RA, Grijalva CG, Hung AM, Liu X, et al. Risk of hypoglycemia following intensification of metformin treatment with insulin versus sulfonylurea. CMAJ Can Med Assoc J J Assoc Medicale Can. 2016;188(6):E104-12.
35. Davies MJ, D’Alessio DA, Fradkin J, Kernan WN, Mathieu C, Mingrone G, et al. Management of hyperglycaemia in type 2 diabetes, 2018. A consensus report by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD). Diabetologia. 2018;61(12):2461-98.
36. Barranco RJ, Gomez-Peralta F, Abreu C, Delgado M, Palomares R, Romero F, et al. Incidence and care-related costs of severe hypoglycaemia requiring emergency treatment in Andalusia (Spain): the PAUEPAD project. Diabet Med J Br Diabet Assoc. 2015;32(11):1520-6.
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