Risk factors, clinical characteristics, and outcomes of hypoglycaemia at a tertiary care hospital in Sri Lanka: A prospective observational study

Introduction: Hypoglycaemia represents a significant clinical challenge globally, particularly in resource-limited settings and among patients with diabetes mellitus (DM) and chronic kidney disease (CKD). Limited data is available on the clinical patterns and outcomes of hypoglycaemia in these populations. This study aimed to analyse risk factors, clinical characteristics, and outcomes of patients with hypoglycaemia presenting to a tertiary care centre in Sri Lanka.
Methods: A prospective observational study was carried out at the Colombo North Teaching Hospital from June to December 2024. Adult patients presenting with capillary blood glucose <70 mg/dL were enrolled using consecutive sampling. Data were collected through structured interviews and review of medical records.
Results: We studied 58 patients (mean age 65 years, 53.4% female) admitted with hypoglycaemia. DM was present in 52 patients (89.7%), with 33/52 (63.5%) having disease duration of less than 10 years. CKD affected 34/52 diabetic patients (65.4%), while 2 patients had hypoglycaemia with CKD but without diabetes. Only 4/52 diabetic patients (7.7%) had recent HbA1c recordings. Among diabetic patients, 30/52 (57.7%) were on high-dose gliclazide, 13/52 (25%) on insulin, and 11/52 (21.2%) on combination sulfonylurea-insulin therapy. Severe hypoglycaemia (level 3) occurred in 50/58 patients (86.2%), while level 1 and level 2 hypoglycaemia occurred in 4/58 patients each (6.9%). Common precipitating factors were reduced oral intake in 29/58 (50%), high-dose antidiabetic therapy in 27/58 (46.6%), and sepsis in 23/58 (39.7%). Mortality was 12.1% (7/58), with higher rates observed in those with advanced CKD and malnutrition.
Conclusions: Hypoglycaemia is a common yet often overlooked healthcare challenge. Elderly diabetic patients with multiple comorbidities, especially CKD, are the most vulnerable. Inadequate glycaemic monitoring and high-dose sulfonylurea use significantly contributed to severe episodes. Focus should be on improving diabetes education, optimising medication, and providing targeted care for vulnerable groups.