Hypoglycemia commonly occurs in patients who are being treated for diabetes. In some cases, these patients suffer from severe
hypoglycemia that requires medical assistance and which can unfortunately result in long-term disabilities. Therefore, we investigated risk factors associated with severe
hypoglycemia requiring medical assistance (HMA) and the resulting neurological sequelae in patients with diabetes. This investigation was a case-control study that assessed 129 patients with diabetes and documented
hypoglycemia from a single tertiary hospital between February 2013 and May 2015. They were treated with oral
hypoglycemic agents alone (54%) or with
insulin with/without oral
hypoglycemic agents (46%). If a patient with diabetes visited the emergency department due to
hypoglycemia, this was defined as HMA. The control group was composed of patients with documented, nonsevere
hypoglycemia who visited the outpatient clinic during the same period. The degree of neurological disability in the HMA patients was measured using the modified Rankin Scale. A multivariate analysis revealed that independent risk factors of HMA were associated with a lack of the self-monitoring of
blood glucose (SMBG) and previous episodes of severe
hypoglycemia. In the HMA group, 15 patients (22%) had neurological sequelae at the time of discharge. Patients with neurological sequelae were older than those without sequelae (74.3 years vs 65.8 years, P = 0.006) and had increased psychological evidence of disorders such as
insomnia,
dementia, and depression (40% vs 11%, P = 0.017). Patients with sequelae were also more likely to live in rural areas (47% vs 19%, P = 0.04) and to have a longer time from last seen normal till
glucose administration (5.2 hours vs 1.6 hours, P = 0.027). In the present study, absence of SMBG and previous severe
hypoglycemic episodes were independent risk factors of HMA and patients with an older age, a psychological disorder, a rural residence, and a prolonged duration of
hypoglycemia had higher risks of neurological sequelae. Therefore, the present findings suggest that physicians should aim to prevent
hypoglycemia in patients with a history of
hypoglycemia and provide education for these patients regarding regular SMBG.