Influencing factors for inadequate hypoglycemia in insulin tolerance test

Abstract

Objective To investigate the influencing factors of inadequate hypoglycemia after insulin injection at the guideline-recommended dose in the insulin tolerance test (ITT). Methods A cross-sectional study was conducted on 416 patients with suspected adult growth hormone (GH) deficiency (121 males and 295 females) in the outpatient department and inpatient department of endocrinology in the First Affiliated Hospital of Chongqing Medical University from January 2010 to December 2021. All patients completed the ITT. The clinical data and biochemical information of the patients were collected, according to whether hypoglycemia was sufficient after a single dose of insulin injection (0.1~0.15 U/kg) recommended by the guidelines during ITT. The patients were divided into the adequate group (n=321) and the inadequate group (n=95). Multivariate logistic regression model was used to analyze the influencing factors of inadequate hypoglycemia. The receiver operating characteristic (ROC) curve was used to analyze the predictive value of relevant indicators for inadequate hypoglycemia and to get the cut-off value. Results Age, BMI, initial insulin dose, baseline blood glucose, baseline GH, fasting insulin, glycated hemoglobin A1c (HbA1c), low density lipoprotein cholesterin(LDL-C) and triglyceride(TG) in the sufficient hypoglycemia group were lower than those in the inadequate hypoglycemia group, and high density lipoprotein cholesterin (HDL-C) was higher than that in the hypoglycemia group (P < 0.05). Multivariate logistic regression model showed that high BMI, high baseline blood glucose, high LDL-C level and low HDL-C level were the influencing factors of inadequate hypoglycemia (P < 0.05). The area under ROC curve (AUC) of BMI predicting hypoglycemia was 0.880, and the cut-off point of BMI calculated by Jorden index was 24.012, with a sensitivity of 0.832 and specificity of 0.804. The AUC of BMI, baseline blood glucose, LDL-C and HDL-C in the combined diagnosis of inadequate hypoglycemia was 0.909 (sensitivity, 0.895; specificity, 0.782). Conclusion High BMI, high baseline blood glucose, high LDL-C level and low HDL-C level are the influencing factors of inadequate hypoglycemia. The combined detection of these 4 factors and BMI single index both have a high predictive value on inadequate hypoglycemia.

Keywords

• insulin tolerance test
• influencing factors
• inadequate hypoglycemia