Abstract:

Background: Hypoglycemia mainly happens diabetic patients who are on medications, similarly the lack of awareness or knowledge of Hypoglycemia symptoms and early management among patients may delay its identification and treatment, similarly neglecting these symptoms could cause a poorer outcome or mortality. Despite the adequate treatment of diabetes, it is estimated 15%-20% of people with diabetes are struggling with a moderate to severe form of depression daily. Little is known about depression in diabetes in East Africa, particularly in Tanzania, and the association of comorbid depression with severe Hypoglycemia episodes. This study aimed to assess the awareness of symptoms and early management of Hypoglycemia among diabetic patients in a primary healthcare facility and association of depression with increased risk of severe hypoglycemic episodes.

Method: A hospital based cross-sectional study was done among 120 diabetic patients attending inpatients in the wards and outpatients in the diabetic clinic in Nyakahanga DDH hospital in 2020, patients with diabetes for over 2 years were included in the study. After obtaining consent the demographics, knowledge on the symptoms and early management of Hypoglycemia were collected, data was analysed by frequency, measures of central tendency by mean and median, percentages and cross tabulation for association using IBM SPSS 23 software.

Results: This study included 120 diabetic patients, with which 58.3% were females and 4.7% males. The largest are group was above 60 years with the prevalence of 43.3% and only 16.7% below the age of 50 years. The timeframe was 2 to 10 years for 70.8% of participants and 29.2% had DM for more than 10 years. A total of 98 patients (81.7%) reported to have experienced Hypoglycemia and among them 13.3% reported to experience Hypoglycemia very many times, 35% many times, 33.3% few times, and the rest 22 patients (18.3%) have never had Hypoglycemic symptoms. Overall 60% of diabetic patients had awareness of the least 3 symptoms of Hypoglycemia together with at least one precipitating factor and at least one remedial measure and were considered to have good knowledge of Hypoglycemia. Based on the depression assessment tool which is the modified patient health questionnaire 9 (PHQ-9), 55.8% of patients had mild depression and 32.5% had moderate depression and 11.7% had minimal depression. Presence of health insurance having information source from health workers and diabetic clinic were associated with good awareness of Hypoglycemia. While alcohol drinking was associated with increased Hypoglycemic episodes, depression was found to increase with age and associated with frequency of Hypoglycemia, marital status, gender, oral Hypoglycemic use and level of education.

Conclusion: Although knowledge of symptoms remedial measures and early prevention of Hypoglycemic episodes was good the diabetic patients both type 1 and type 2. There was a gap in knowledge regarding the complications of longstanding Hypoglycemia and the significance of self-testing of blood glucose at home and target level of Hypoglycemia. Similarly the features of depression were less known to patient’s caretakers and patients themselves. The study revealed that presence of depression is associated with occurrence of severe hypoglycemic episodes. Therefore there is a need for healthcare workers and the government to create strategies towards educating the population about complications and the associated depression symptoms associated with Hypoglycemia and diabetes in general.