Prevalence and characteristics of factitious hypoglycaemia in non‐diabetic patients in a department of endocrinology

• Published in: Endocrinology, diabetes & metabolism Vol. 5; no. 6; pp. e375 - n/a
• Main Authors: Oueslati, Ibtissem, Terzi, Amani, Yazidi, Meriem, Kamoun, Elyes, Chihaoui, Melika
• Format: Journal Article
• Language: English
• Published: England John Wiley & Sons, Inc 01.11.2022; John Wiley and Sons Inc; Wiley
• Subjects: Adult; Age; Body mass index; Diabetes; Diabetes Mellitus - epidemiology; Endocrinology; Etiology; factitious hypoglycaemia; Family medical history; Fasting; Female; Glucose; Humans; hypoglycaemia in non‐diabetic patients; Hypoglycemia; Hypoglycemia - diagnosis; Hypoglycemia - epidemiology; Hypoglycemia - etiology; Insulin; Insulin - adverse effects; insulin secretagogues medications; Male; Medical profession; Mental disorders; Mortality; Pancreatic Neoplasms - chemically induced; Pancreatic Neoplasms - complications; Peptides; Prevalence; psychiatric care; Retrospective Studies; Self destructive behavior; Statistical analysis; Suicides & suicide attempts; Variables; insulin secretagogues medications; factitious hypoglycaemia; psychiatric care; hypoglycaemia in non-diabetic patients; insulin
• ISSN: 2398-9238; 2398-9238
• DOI: 10.1002/edm2.375

Introduction Factitious hypoglycaemia is defined as the surreptitious use of insulin or oral hypoglycaemic agents to deliberately induce self‐harm. It represents a challenging diagnosis and misdiagnosis is associated with significant morbidity and mortality. The aim of this study was to assess the prevalence and the associated factors of factitious hypoglycaemia in non‐diabetic patients. Methods This was a single‐centre, retrospective study including 70 non‐diabetic patients who were admitted for the investigation of hypoglycaemia. All patients fulfilled the Whipple triad. Epidemiological parameters, medical history, clinical and paraclinical data and the aetiology of hypoglycaemia were collected from medical records. Results The diagnosis of factitious hypoglycaemia was held in 11 patients (9 women and 2 men) corresponding to a prevalence of 16%. It was secondary to intentional insulin use in six patients and the ingestion of glibenclamide in five patients. The median age of the patients was 28 years (interquartile range: 21–43). Two patients with factitious hypoglycaemia had a personal history of psychiatric disorders. The other causes of hypoglycaemia were adrenal insufficiency (34%), prediabetes (24%), insulinoma (6%), iatrogenic hypoglycaemia (10%), criminal hypoglycaemia (1%) and alcohol intoxication (2%). Age ≤ 35 years (Odds Ratio = 5.6, p = .017), family history of diabetes mellitus (Odds Ratio = 1.29, p = .015), attention disorders during hypoglycaemia (Odds Ratio = 12.5, p = .017) and fasting glucose level <0.7 g/L (Odds Ratio = 5.75, p = .017) were positively associated with factitious hypoglycaemia. Conclusion Factors significantly associated with factitious hypoglycaemia were young age, family history of diabetes and a low fasting glucose level. According to our data, the significant differences between the reference population (other causes of hypoglycemia) and factitious hypoglycemia were age, family history of diabetes and a lower fasting glucose levels. A psychiatric referral is warranted to provide the appropriate care for patients.