Assessing Prevalence and Predictors of Impaired Awareness of Hypoglycemia in Type 2 Diabetes Patients with Chronic Kidney Disease

Abstract

Background This study aims to determine the prevalence of impaired awareness of hypoglycemia (IAH) across all chronic kidney disease stages in patients with type 2 diabetes mellitus and to identify predictors of impaired awareness of hypoglycemia within these patients. Methods clinical and laboratory data were extracted from patient medical records. Participants were interviewed using validated modified Clarke’s questionnaire and Gold score to assess impaired awareness of hypoglycemia. Results Cross sectional study included 480 participants with chronic kidney disease and type 2 diabetes. Distribution across chronic kidney disease stages was as follows: 70 patients in stages 1–2, 126 in stage 3, 136 in stage 4, 33 in stage 5 on conservative treatment, and 115 in stage 5 on hemodialysis. The overall prevalence of impaired awareness of hypoglycemia (IAH) was 34.6% (166 patients) according to the Clarke questionnaire and 34.4% by the Gold Score (165 patients). This prevalence varied significantly across different CKD stages, being notably higher in stage 3 and lower in stage 5, regardless of treatment modality (P value = 0.001). The mean impaired awareness of hypoglycemia scores were 3.98 ± 1.34 (Clarke) and 3.92 ± 1.52 (Gold), with advanced CKD stages showing statistically significant elevated scores (p value ≤ 0.05). In the 166 patients with impaired awareness of hypoglycemia, a statistically significant lower prevalence of severe hypoglycemia was observed in the early CKD stages (p value = 0.01). Most of patients with impaired awareness of hypoglycemia aged > 60 years, had more prevalent hypertension and had lower HbA1c levels (P value ≤ 0.05). However, Multivariate logistic regression analysis found that age > 60 years was a significant independent risk factor with an 8% higher risk for IAH (P = 0.01), (OR 1.08, 95% CI 1.01–1.16). Conclusion Patients with chronic kidney disease stage 3 and type 2 DM are more prone to IAH but those with already IAH with advanced CKD stages experience more severe hypoglycemic episodes. Age over 60 years was an independent risk factor for hypoglycemia unawareness in this patient group. Larger wide scale studies are needed to further validate these results.