Observational Study
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Diabetes. Jul 15, 2021; 12(7): 1131-1140
Published online Jul 15, 2021. doi: 10.4239/wjd.v12.i7.1131
Fasting biochemical hypoglycemia and related-factors in non-diabetic population: Kanagawa Investigation of Total Check-up Data from National Database-8
Kotone Tanaka, Ryoko Higuchi, Kaori Mizusawa, Teiji Nakamura, Kei Nakajima
Kotone Tanaka, Graduate School of Health Innovation, Kanagawa University of Human Services, Kawasaki 210-0821, Japan
Ryoko Higuchi, Kaori Mizusawa, Teiji Nakamura, Kei Nakajima, School of Nutrition and Dietetics, Faculty of Health and Social Services, Kanagawa University of Human Services, Yokosuka 238-8522, Japan
Kei Nakajima, Department of Endocrinology and Diabetes, Saitama Medical Center, Saitama Medical University, Kawagoe 350-8550, Japan
Author contributions: Nakajima K and Nakamura T conceived and designed original study; Tanaka K and Nakajima K analyzed the data; Higuchi R and Mizusawa K prepared the documents related to the study and organized the data; Tanaka K and Nakajima K wrote the first draft of the manuscript.
Institutional review board statement: The study was reviewed and approved by the Ethics Committee of Kanagawa University of Human Services Institutional Review Board.
Informed consent statement: Informed written consent was waived.
Conflict-of-interest statement: The authors declare that they have no conflict-of-interest.
Data sharing statement: Not available.
STROBE statement: The authors have read the STROBE statement, and the manuscript was prepared and revised according to the STROBE statement.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Kei Nakajima, MD, PhD, Doctor, Professor, School of Nutrition and Dietetics, Faculty of Health and Social Services, Kanagawa University of Human Services, 1-10-1 Heisei-cho, Yokosuka 238-8522, Japan. nakajima-rsh@kuhs.ac.jp
Received: February 8, 2021
Peer-review started: February 8, 2021
First decision: April 20, 2021
Revised: April 28, 2021
Accepted: June 22, 2021
Article in press: June 22, 2021
Published online: July 15, 2021
Processing time: 153 Days and 22.2 Hours
Abstract
BACKGROUND

In healthy people, the lowest daily blood glucose concentration is usually observed in the early morning, after overnight fasting. However, the clinical relevance and the prevalence of fasting biochemical hypoglycemia (FBH) are poorly understood in people who do not have diabetes, although the clinical implications of such hypoglycemia have been extensively studied in patients with diabetes. FBH can be influenced by many factors, including age, sex, body mass, smoking, alcohol drinking, exercise levels, medications, and eating behaviors, such as breakfast skipping and late-night eating.

AIM

To determine the prevalence of FBH and investigated its association with potential risk factors in a population without diabetes.

METHODS

Clinical parameters and lifestyle-related factors were assessed in a cross-sectional study of 695613 people aged 40-74 years who had undergone a health check-up (390282 men and 305331 women). FBH was defined as fasting plasma glucose < 70 mg/dL (3.9 mmol/L) after overnight fasting, regardless of any symptoms. The absence of diabetes was defined as HbA1c < 6.5%, fasting plasma glucose < 126 mg/dL (7.0 mmol/L), and no pharmacotherapy for diabetes. Multivariate logistic regression analysis, with adjustment for confounding factors, was used to identify associations.

RESULTS

FBH was present in 1842 participants (0.26%). There were significantly more women in the FBH group (59.1%) than in the non-FBH group (43.9%). Values of most of the clinical parameters, but not age, were significantly lower in the FBH group than in the non-FBH group. Logistic regression analysis showed that a body mass index of ≤ 20.9 kg/m2 (reference: 21-22.9 kg/m2) and current smoking were significantly associated with FBH, and this was not altered by adjustment for age, sex, and pharmacotherapy for hypertension or dyslipidemia. Female sex was associated with FBH. When the data were analyzed according to sex, men in their 60s or 70s appeared more likely to experience FBH compared with their 40s, whereas men in their 50s and women aged ≥ 50 years appeared less likely to experience FBH. The relationships of FBH with other factors including alcohol drinking and pharmacotherapies for hypertension and dyslipidemia also differed between men and women.

CONCLUSION

FBH occurs even in non-diabetic people, albeit at a very low frequency. FBH is robustly associated with low body mass and smoking, and its relationship with lifestyle factors varies according to sex.

Keywords: Hypoglycemia, Body mass index, Age, Smoking, Women, Breakfast skipping

Core Tip: The clinical relevance of fasting biochemical hypoglycemia (FBH) is poorly understood in people who do not have diabetes. Therefore, we determined the prevalence of FBH and its relationships with other parameters in approximately 700000 people who did not have diabetes. FBH was identified in 0.26% of the participants and women were over-represented among these (59.1%). Low body mass and smoking were associated with FBH in both men and women. Women and men in their 60s and 70s were more likely to experience FBH, and the relationships of FBH with other factors differed between men and women.