Skip to content
2000
  1. Home
  2. A-Z Publications
  3. Current Diabetes Reviews
  4. Volume 21, Issue 1
  5. Article
Volume 21, Issue 1
  • ISSN: 1573-3998
  • E-ISSN: 1875-6417
file format text download EPUB
file format pdf download PDF
side by side viewer icon HTML

Abstract

Background

Hypoglycemia is an acute episode that can lead to death in patients with diabetes mellitus (DM). This condition is preventable with patient education, and identifying factors influencing their occurrence is essential to creating effective and efficient education. It also leads to prevention and control by re-organizing the service system and diabetes policies. This study aimed to determine factors contributing to hypoglycemic episodes in type 2 DM outpatients covered by the state-provided (JKN) health insurance.

Methods

The study used a cross-sectional design and collected data from five regional general hospitals in Jakarta, Indonesia. The outpatients were sampled consecutively from two hospitals in September–November 2021, one in January–March 2022, and two others in April–June 2023. Interviews produced primary data related to experienced hypoglycemic episodes, and medical records provided secondary data on patients' clinical characteristics and treatments. Binary logistic regression analysis was employed to process the contributing factors statistically.

Results

From 501 patients who met the inclusion and exclusion criteria, it was found that the prevalence of hypoglycemia was 53.3%. Factors that significantly increased hypoglycemic risk ( < 0.05) were high HbA1c levels (OR 1.9; 95% CI 1.2–2.9), comorbidities (OR 1.6; 95% CI 1.1–2.4), insulin/sulfonylurea therapy (OR 2; 95% CI 1–4), non-smoking habit (OR 2.2; 95% CI 1.3–3.6) and physically active lifestyle (OR 1.8; 95% CI 1.2–2.6).

Conclusion

The prevalence of hypoglycemia in type 2 diabetes mellitus (DM) outpatients with the state-provided health insurance (JKN) at general hospitals in Jakarta is high. The diabetes self-management education (DSME) services provided by health professionals for these outpatients must be further improved.

© 2025 Bentham Science Publishers
© 2025 The Author(s). Published by Bentham Science Publishers. This is an open access article published under CC BY 4.0 https://creativecommons.org/licenses/by/4.0/legalcode
Loading

Article metrics loading...

/content/journals/cdr/10.2174/0115733998280552231228064154
2024-01-11
2025-05-18

  • From This Site

    /content/journals/cdr/10.2174/0115733998280552231228064154
    dcterms_title,dcterms_subject,pub_keyword
    -contentType:Contributor -contentType:Concept -contentType:Institution
    10
    5
The full text of this item is not currently available.

References

  1. Diabetes Atlas IDF. IDF Diabetes Atlas2021
     [Google Scholar]
  2. Indonesian Ministry of Health National Health Research Report.Jakarta2019
     [Google Scholar]
  3. AlkaffF.F. IllaviF. SalamahS. The impact of the indonesian chronic disease management program (PROLANIS) on metabolic control and renal function of type 2 diabetes mellitus patients in primary care setting.J. Prim. Care Community Health20211210.1177/2150132720984409 33472499
     [Google Scholar]
  4. KhoeL.C. WanggeG. SoewondoP. TahaparyD.L. WidyaheningI.S. The implementation of community-based diabetes and hypertension management care program in Indonesia.PLoS One2020151e022780610.1371/journal.pone.0227806 31935256
     [Google Scholar]
  5. Indonesian Ministry of HealthDecree of the Minister of Health Number HK. In: 0107/MENKES/6485/2021 on the National Formulary.2021
     [Google Scholar]
  6. Indonesian endocrinology association guidelines for the management and prevention of type 2 diabetes mellitus in adults in Indonesia.PB Perkeni2021
     [Google Scholar]
  7. DaviesM.J. D’AlessioD.A. FradkinJ. Management of hyperglycemia in type 2 diabetes, 2018. A consensus report by the american diabetes association (ADA) and the European association for the study of diabetes (EASD).Diabetes Care201841122669270110.2337/dci18‑0033 30291106
     [Google Scholar]
  8. AnnisaB.S. PuspitasariC.E. AiniS.R. Profil penggunaan obat antidiabetes pada pasien diabetes mellitus tipe 2 di instalasi rawat jalan RSUD Provinsi NTB tahun 2018.Sasambo J Pharm202121374110.29303/sjp.v2i1.74
     [Google Scholar]
  9. Binti SappoN. RahmawatiD. RamadhanA.M. Pharmaceutical research and development L, tropis F. characteristics and patterns of anti-diabetic drug use in type 2 diabetes mellitus patients at Abdul Wahab Sjarahranie Regional Hospital.Proceeding of Mulawarman Pharmaceuticals Conferences417
     [Google Scholar]
  10. ErogluN. SabuncuN. The effect of education given to type 2 diabetic individuals on diabetes self-management and self-efficacy: Randomized controlled trial.Prim. Care Diabetes202115345145810.1016/j.pcd.2021.02.011 33674221
     [Google Scholar]
  11. NorrisS. NicholsP. CaspersenC. Increasing diabetes self-management education in community settings a systematic review.Am. J. Prev. Med.2002224Suppl.396610.1016/S0749‑3797(02)00424‑5 11985934
     [Google Scholar]
  12. GreenwayF.L. Severe hypoglycemia in the look ahead trial.J. Diabetes Complications201630593594310.1016/j.jdiacomp.2016.03.016 27114389
     [Google Scholar]
  13. IlohG.P. AmadiA. Epidemiology of hypoglycemia among ambulatory Type 2 diabetic patients in a primary care clinic of a tertiary hospital in Southeastern Nigeria.J Health Res Rev2018525710.4103/jhrr.jhrr_37_17
     [Google Scholar]
  14. ShriraamV. MahadevanS. AnitharaniM. Reported hypoglycemia in Type 2 diabetes mellitus patients: Prevalence and practices-a hospital-based study.Indian J. Endocrinol. Metab.201721114815310.4103/2230‑8210.196002 28217515
     [Google Scholar]
  15. Snell-BergeonJ.K. WadwaR.P. Hypoglycemia, diabetes, and cardiovascular disease.Diabetes Technol. Ther.201214S1Suppl. 1S-51S-5810.1089/dia.2012.0031 22650225
     [Google Scholar]
  16. MoralesJ. SchneiderD. Hypoglycemia.Am. J. Med.201412710Suppl.S17S2410.1016/j.amjmed.2014.07.004 25282009
     [Google Scholar]
  17. BesenDB SurucuHA KoşarC Self-reported frequency, severity of, and awareness of hypoglycemia in type 2 diabetes patients in Turkey PeerJ20162016
     [Google Scholar]
  18. van MeijelL.A. de VegtF. AbbinkE.J. High prevalence of impaired awareness of hypoglycemia and severe hypoglycemia among people with insulin-treated type 2 diabetes: The dutch diabetes pearl cohort.BMJ Open Diabetes Res. Care202081e00093510.1136/bmjdrc‑2019‑000935 32107264
     [Google Scholar]
  19. HusseinZ. KamaruddinN.A. ChanS.P. JainA. UppalS. BebakarW.M.W. Hypoglycemia awareness among insulin-treated patients with diabetes in Malaysia: A cohort subanalysis of the HAT study.Diabetes Res. Clin. Pract.2017133404910.1016/j.diabres.2017.08.007 28888148
     [Google Scholar]
  20. BainA. KavanaghS. McCarthyS. BabarZ.U.D. Assessment of insulin-related knowledge among healthcare professionals in a large teaching hospital in the united kingdom.Pharmacy2019711610.3390/pharmacy7010016 30704103
     [Google Scholar]
  21. RezendeP.C. EverettB.M. BrooksM.M. Hypoglycemia and elevated troponin in patients with diabetes and coronary artery disease.J. Am. Coll. Cardiol.201872151778178610.1016/j.jacc.2018.07.067 30286920
     [Google Scholar]
  22. HellerS.R. GeybelsM.S. IqbalA. LiuL. WagnerL. ChowE. A higher non-severe hypoglycaemia rate is associated with an increased risk of subsequent severe hypoglycaemia and major adverse cardiovascular events in individuals with type 2 diabetes in the LEADER study.Diabetologia2021 34704120
     [Google Scholar]
  23. Echouffo-TcheuguiJ.B. DayaN. LeeA.K. Severe hypoglycemia, cardiac structure and function, and risk of cardiovascular events among older adults with diabetes.Diabetes Care202144124825410.2337/dc20‑0552 33199469
     [Google Scholar]
  24. QuilliamB.J. SimeoneJ.C. OzbayA.B. KogutS.J. The incidence and costs of hypoglycemia in type 2 diabetes.Am. J. Manag. Care20111710673680 22106460
     [Google Scholar]
  25. AljunidS.M. AungY.N. IsmailA. Economic burden of hypoglycemia for type II diabetes mellitus patients in Malaysia.PLoS One20191410e021124810.1371/journal.pone.0211248 31652253
     [Google Scholar]
  26. StrizekA. ChangC.J. FurnbackW. WangB. LebrecJ. LewT. The cost of hypoglycemia associated with type 2 diabetes mellitus in Taiwan.Value Health Reg. Issues201918849010.1016/j.vhri.2019.01.002 30776767
     [Google Scholar]
  27. HidayatB. RamadaniR.V. RudijantoA. SoewondoP. SuastikaK. Siu NgJ.Y. Direct medical cost of type 2 diabetes mellitus and its associated complications in Indonesia.Value Health Reg. Issues202228828910.1016/j.vhri.2021.04.006 34839111
     [Google Scholar]
  28. HallT.A. Designing culturally relevant educational materials for Mexican American clients.Diabetes Educ.198713328128510.1177/014572178701300308 3665715
     [Google Scholar]
  29. ParkJ.S. AhnC.W. Educational program for diabetic patients in Korea—Multidisplinary intensive management.Diabetes Res. Clin. Pract.2007773Suppl. 1S194S19810.1016/j.diabres.2007.01.056 17448562
     [Google Scholar]
  30. LaMannaJ. LitchmanM.L. DickinsonJ.K. Diabetes education impact on hypoglycemia outcomes: A systematic review of evidence and gaps in the literature.Diabetes Educ.201945434936910.1177/0145721719855931 31210091
     [Google Scholar]
  31. RudijantoA. SaraswatiM.R. YunirE. KumalaP. PuteriH.H.S. MandangV.V.V. Indonesia cohort of IO HAT study to evaluate diabetes management, control, and complications in retrospective and prospective periods among insulin-treated patients with type 1 and type 2 diabetes.Acta Med. Indones.20185012637 29686173
     [Google Scholar]
  32. SeaquistE.R. AndersonJ. ChildsB. Hypoglycemia and diabetes: A report of a workgroup of the American Diabetes Association and the Endocrine Society.Diabetes Care20133651384139510.2337/dc12‑2480 23589542
     [Google Scholar]
  33. RickelsM.R. Hypoglycemia‐associated autonomic failure, counterregulatory responses, and therapeutic options in type 1 diabetes.Ann. N. Y. Acad. Sci.201914541687910.1111/nyas.14214 31389033
     [Google Scholar]
  34. MohseniM. AhmadiS. Azami-AghdashS. Challenges of routine diabetes care during COVID-19 era: A systematic search and narrative review.Prim. Care Diabetes202115691892210.1016/j.pcd.2021.07.017 34393092
     [Google Scholar]
  35. ParkinC.G. DavidsonJ.A. Value of self-monitoring blood glucose pattern analysis in improving diabetes outcomes.J. Diabetes Sci. Technol.20093350050810.1177/193229680900300314 20144288
     [Google Scholar]
  36. KlonoffD.C. The current status of Health for diabetes: Will it be the next big thing?J. Diabetes Sci. Technol.20137374975810.1177/193229681300700321 23759409
     [Google Scholar]
  37. KachevaS. KargesB. GöllerK. MarxN. MischkeK. KargesW. QT prolongation caused by insulin-induced hypoglycaemia – An interventional study in 119 individuals.Diabetes Res. Clin. Pract.201712316517210.1016/j.diabres.2016.11.021 28024277
     [Google Scholar]
  38. PearsonS.M. WhittamB. KulavarasalingamK. Mitchell-GearsA. JamesC. AjjanR.A. Reduction in cardiovascular mortality following severe hypoglycemia in individuals with type 2 diabetes: The role of a pragmatic and structured intervention.Cardiovasc. Diabetol.20212011810.1186/s12933‑020‑01204‑3 33435992
     [Google Scholar]
  39. LamounierR.N. GelonezeB. LeiteS.O. Hypoglycemia incidence and awareness among insulin-treated patients with diabetes: The HAT study in Brazil.Diabetol. Metab. Syndr.20181018310.1186/s13098‑018‑0379‑5 30479669
     [Google Scholar]
  40. BorzìV. FrassonS. GussoniG. Risk factors for hypoglycemia in patients with type 2 diabetes, hospitalized in internal medicine wards: Findings from the FADOI-DIAMOND study.Diabetes Res. Clin. Pract.2016115243010.1016/j.diabres.2016.01.020 27242119
     [Google Scholar]
  41. AvariP. MoscardoV. JugneeN. OliverN. ReddyM. Glycemic variability and hypoglycemic excursions with continuous glucose monitoring compared to intermittently scanned continuous glucose monitoring in adults with highest risk type 1 diabetes.J. Diabetes Sci. Technol.202014356757410.1177/1932296819867688 31375042
     [Google Scholar]
  42. MalkaniS KotwalA Frequency and predictors of self-reported hypoglycemia in insulin-treated diabetes.J Diabetes Res20172017
     [Google Scholar]
  43. LeeA.K. LeeC.J. HuangE.S. SharrettA.R. CoreshJ. SelvinE. Risk factors for severe hypoglycemia in black and white adults with diabetes: The atherosclerosis risk in communities (ARIC) study.Diabetes Care201740121661166710.2337/dc17‑0819 28928117
     [Google Scholar]
  44. AkirovA. AmitaiO. Masri-IraqiH. Predictors of hypoglycemia in hospitalized patients with diabetes mellitus.Intern. Emerg. Med.201813334335010.1007/s11739‑018‑1787‑0 29340912
     [Google Scholar]
  45. AuN.H. Ratzki-LeewingA. ZouG. RyanB.L. Webster-BogaertS. ReichertS.M. Real-world incidence and risk factors for daytime and nocturnal non-severe hypoglycemia in adults with type 2 diabetes mellitus on insulin and/or secretagogues (InHypo-DM Study, Canada).Can. J. Diabetes2021 35288040
     [Google Scholar]
  46. NuzzoA. BrignoliA. Chantal PonzianiM. ZavattaroM. ProdamF. CastelloL.M. Aging and comorbidities influence the risk of hospitalization and mortality in diabetic patients experiencing severe hypoglycemia.Nutr. Metab. Cardiovasc. Dis.2021 34802847
     [Google Scholar]
  47. LvX. FangK. HaoW. HanY. YangN. YuQ. Identification of reactive hypoglycemia with different basic bmi and its causes by prolonged oral glucose tolerance test.Diabetes Metab. Syndr. Obes.2020134717472610.2147/DMSO.S280084 33293845
     [Google Scholar]
  48. Bie-OlsenL.G. Pedersen-BjergaardU. KjærT.W. LonsdaleM.N. LawI. ThorsteinssonB. Differences in cortical and pituitary activity in response to hypoglycaemia and cognitive testing in healthy men with different basal activity of the renin-angiotensin system.J. Renin Angiotensin Aldosterone Syst.201011317317910.1177/1470320310364182 20215476
     [Google Scholar]
  49. EnslingM. SteinmannW. Whaley-ConnellA. Hypoglycemia: A possible link between insulin resistance, metabolic dyslipidemia, and heart and kidney disease (the Cardiorenal Syndrome).Cardiorenal Med.201111677410.1159/000322886 22258467
     [Google Scholar]
  50. PratiwiC. MokoagowM.I. Made KshantiI.A. SoewondoP. The risk factors of inpatient hypoglycemia: A systematic review.Heliyon202065e0391310.1016/j.heliyon.2020.e03913 32420485
     [Google Scholar]
  51. RayC.Y. WuV.C.C. WangC.L. Hypoglycemia associated with drug–drug interactions in patients with type 2 diabetes mellitus using dipeptidylpeptidase-4 inhibitors.Front. Pharmacol.20211257083510.3389/fphar.2021.570835 34040513
     [Google Scholar]
  52. RomleyJ.A. GongC. JenaA.B. GoldmanD.P. WilliamsB. PetersA. Association between use of warfarin with common sulfonylureas and serious hypoglycemic events: Retrospective cohort analysis.BMJ2015351h622310.1136/bmj.h6223 26643108
     [Google Scholar]
  53. ThamerM. RayN.F. TaylorT. Association between antihypertensive drug use and hypoglycemia: A case-control study of diabetic users of insulin or sulfonylureas.Clin. Ther.19992181387140010.1016/S0149‑2918(99)80039‑3 10485510
     [Google Scholar]
  54. ParekhT.M. RajiM. LinY.L. TanA. KuoY.F. GoodwinJ.S. Hypoglycemia after antimicrobial drug prescription for older patients using sulfonylureas.JAMA Intern. Med.2014174101605161210.1001/jamainternmed.2014.3293 25179404
     [Google Scholar]
  55. SonodaN. MorimotoA. UgiS. Predictors for mild and severe hypoglycemia in insulin-treated Japanese diabetic patients.PLoS One2015106e013058410.1371/journal.pone.0130584 26102197
     [Google Scholar]
  56. NassarD.T. HabibO.S. MansourA.A. Predictors of hypoglycemia in insulin-treated patients with type 2 diabetes mellitus in Basrah.World J. Diabetes201671847048010.4239/wjd.v7.i18.470 27795821
     [Google Scholar]
  57. AjjanR.A. JacksonN. ThomsonS.A. Reduction in HbA1c using professional flash glucose monitoring in insulin-treated type 2 diabetes patients managed in primary and secondary care settings: A pilot, multicentre, randomised controlled trial.Diab. Vasc. Dis. Res.201916438539510.1177/1479164119827456 31271312
     [Google Scholar]
  58. CuddihyR.M. Philis-TsimikasA. NazeriA. Type 2 diabetes care and insulin intensification: Is a more multidisciplinary approach needed? Results from the MODIFY survey.Diabetes Educ.201137111112310.1177/0145721710388426 21131599
     [Google Scholar]
  59. Gómez-HuelgasR. Sabán-RuizJ. García-RománF.J. Safety and efficacy of a basal-plus regimen with insulin glargine and insulin glulisine for elderly patients with high cardiovascular risk and type 2 diabetes mellitus.Rev Clin Esp2017217420120610.1016/j.rceng.2017.02.004 28314656
     [Google Scholar]
  60. RadosD.V. FalcettaM.R.R. PintoL.C. LeitãoC.B. GrossJ.L. All-cause mortality and cardiovascular safety of basal insulin treatment in patients with type 2 diabetes mellitus: A systematic review with meta-analysis and trial sequential analysis.Diabetes Res. Clin. Pract.202117310868810.1016/j.diabres.2021.108688 33549676
     [Google Scholar]
  61. MannucciE. TargherG. NreuB. Effects of insulin on cardiovascular events and all-cause mortality in patients with type 2 diabetes: A meta-analysis of randomized controlled trials.Nutr. Metab. Cardiovasc. Dis.20223261353136010.1016/j.numecd.2022.03.007 35422359
     [Google Scholar]
  62. LiZ. ZhangY. QuanX. Efficacy and acceptability of glycemic control of glucagon-like peptide-1 receptor agonists among type 2 diabetes: A systematic review and network meta-analysis.PLoS One2016115e015420610.1371/journal.pone.0154206 27158818
     [Google Scholar]
  63. XuX. XuW. ZhuoQ. YanY. The efficacy and safety of dapagliflozin combined with oral hypoglycemic agents in patients with type 2 diabetes: A systematic review and meta-analysis.Ann. Palliat. Med.20221131028103710.21037/apm‑22‑121 35365032
     [Google Scholar]
  64. ZhaoJ.Z. WeinhandlE.D. CarlsonA.M. St PeterW.L. Hypoglycemia risk with SGLT2 inhibitors or glucagon-like peptide 1 receptor agonists versus sulfonylureas among medicare insured adults with CKD in the United States.Kidney Med.20224810051010.1016/j.xkme.2022.100510 35898692
     [Google Scholar]
  65. SariM.I. SariN. DarlanD.M. PrasetyaR.J. Cigarette smoking and hyperglycaemia in diabetic patients.Open Access Maced. J. Med. Sci.20186463463710.3889/oamjms.2018.140 29731929
     [Google Scholar]
  66. DuarteC.K. AlmeidaJ.C. MerkerA.J. Brauer FdeO Rodrigues TdaC Physical activity level and exercise in patients with diabetes mellitus.Rev. Assoc. Med. Bras.2012582215221 22569617
     [Google Scholar]
  67. CastonguayA. MiquelonP. BoudreauF. Self-regulation resources and physical activity participation among adults with type 2 diabetes.Health Psychol. Open20185110.1177/2055102917750331 29372066
     [Google Scholar]
  68. ZhuP. PanX.F. ShengL. ChenH. PanA. Cigarette smoking, diabetes, and diabetes complications: Call for urgent action.Curr. Diab. Rep.20171797810.1007/s11892‑017‑0903‑2 28766247
     [Google Scholar]
  69. EliassonB. Cigarette smoking and diabetes.Prog. Cardiovasc. Dis.200345540541310.1016/S0033‑0620(03)80004‑X 12704597
     [Google Scholar]
  70. ArteseA. StamfordB.A. MoffattR.J. Cigarette smoking: An accessory to the development of insulin resistance.Am. J. Lifestyle Med.201913660260510.1177/1559827617726516 31662726
     [Google Scholar]
  71. CampagnaD. AlamoA. Di PinoA. RussoC. CalogeroA.E. PurrelloF. Smoking and diabetes: Dangerous liaisons and confusing relationships.Diabetol Metab20191111210.1186/s13098‑019‑0482‑2
     [Google Scholar]
  72. MaddatuJ. Anderson-BaucumE. Evans-MolinaC. Smoking and the risk of type 2 diabetes.Transl. Res.201718410110710.1016/j.trsl.2017.02.004 28336465
     [Google Scholar]
  73. MaideenNMP Tobacco smoking and its drug interactions with comedications involving CYP and UGT enzymes and nicotine10.5497/wjp.v8.i2.14
     [Google Scholar]
  74. PorterJ.W. Pettit-MeeR.J. ReadyS.T. Post meal exercise may lead to transient hypoglycemia irrespective of glycemic status in humans.Front. Endocrinol.20201157810.3389/fendo.2020.00578 32982972
     [Google Scholar]
  75. YounkL.M. MikeladzeM. TateD. DavisS.N. Exercise-related hypoglycemia in diabetes mellitus.Expert Rev. Endocrinol. Metab.2011619310810.1586/eem.10.78 21339838
     [Google Scholar]
/content/journals/cdr/10.2174/0115733998280552231228064154
Loading
Factors Influencing Hypoglycemia in Type 2 Diabetes Mellitus Outpatients with State Health Insurance at Regional General Hospitals in Jakarta, Indonesia
Curr. Diabetes Rev. 21, E110124225530 (2025); https://doi.org/10.2174/0115733998280552231228064154
/content/journals/cdr/10.2174/0115733998280552231228064154
/content/journals/cdr/10.2174/0115733998280552231228064154
Loading

Data & Media loading...


  • Article Type:     Research Article
Keyword(s): hypoglycemia; Influencing factors; JKN health insurance; outpatient; type 2 DM

Most Cited Most Cited RSS feed

This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error
Please enter a valid_number test